Provider Demographics
NPI:1023158649
Name:DOE, ANDREW L (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:L
Last Name:DOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1213 HERMANN DR
Mailing Address - Street 2:SUITE 255
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7018
Mailing Address - Country:US
Mailing Address - Phone:713-955-1707
Mailing Address - Fax:713-955-1699
Practice Address - Street 1:1213 HERMANN DR
Practice Address - Street 2:SUITE 255
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7018
Practice Address - Country:US
Practice Address - Phone:713-955-1707
Practice Address - Fax:713-955-1699
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2016-02-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2429762085R0202X
NJ25MA083825002085R0202X, 2085R0204X
TXP22302085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX309705701Medicaid
TX309705701Medicaid
NJ125186ZC0QMedicare PIN
NJ112226Medicare PIN
NJ125186ZC3BMedicare PIN
NJ138886WSEMedicare PIN