Provider Demographics
NPI:1982616173
Name:ENRIQUEZ, ANDRES S (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:S
Last Name:ENRIQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:553 CANYON SPRINGS
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912
Mailing Address - Country:US
Mailing Address - Phone:915-478-2400
Mailing Address - Fax:
Practice Address - Street 1:836 E REDD RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7221
Practice Address - Country:US
Practice Address - Phone:915-833-8444
Practice Address - Fax:915-833-8767
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7149207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178232700OtherOWCP DOL
TX2032372OtherUNITED HEALTH CARE
TXMDK7149OtherWORKERS COMPENSATION
TX080165782OtherMEDICARE RAILROAD
NMNM009379OtherBLUE CROSS BLUE SHILD NM
TX628635OtherANTHEM BX
P2139868OtherOXFORD INSURANCE
TX0096EROtherBLUE CROSS BLUE SHILD
TX8A3420OtherBLUE CROSS BLUE SHILD
TXG91755Medicare UPIN
NMNM009379OtherBLUE CROSS BLUE SHILD NM