Provider Demographics
NPI:1154420735
Name:ANDREWS, MARK LEROY (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:LEROY
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:111 W HOBBS ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88203-1869
Mailing Address - Country:US
Mailing Address - Phone:575-623-3311
Mailing Address - Fax:575-622-1273
Practice Address - Street 1:111 W. HOBBS ST.
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-1869
Practice Address - Country:US
Practice Address - Phone:575-623-3311
Practice Address - Fax:575-622-1273
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM99-155207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00078991Medicaid
NME76582Medicare UPIN