Provider Demographics
NPI:1629063409
Name:ANDREWS, ANDREA SEGUE (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:SEGUE
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:D
Other - Last Name:SEGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1102 W MACARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1743
Mailing Address - Country:US
Mailing Address - Phone:405-878-8112
Mailing Address - Fax:
Practice Address - Street 1:1102 W MACARTHUR ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1743
Practice Address - Country:US
Practice Address - Phone:405-878-8112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237057207Q00000X
OK26247207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200229670AMedicaid
VAP00202627OtherRR MEDICARE
VA1629063409Medicaid
OK200229670AMedicaid
VA1629063409Medicaid
OKOK402872Medicare PIN