Provider Demographics
NPI:1639102460
Name:ANDRES, EDWARD H III (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:H
Last Name:ANDRES
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 N. RIVERSIDE RD.,
Mailing Address - Street 2:SUITE G 50
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-2553
Mailing Address - Country:US
Mailing Address - Phone:816-671-4888
Mailing Address - Fax:816-671-4890
Practice Address - Street 1:802 N. RIVERSIDE RD.,
Practice Address - Street 2:SUITE G 50
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-2553
Practice Address - Country:US
Practice Address - Phone:816-671-4888
Practice Address - Fax:816-671-4890
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4278208600000X, 2086S0127X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO10001262101OtherCOMMUNITY HEALTH PLAN
KS100130870BMedicaid
MOP00193414OtherRR MEDICARE
MO200374411Medicaid
KS100130870BMedicaid
C52300Medicare UPIN