Provider Demographics
NPI:1366616484
Name:ANDRADE ORTIZ, WERNER ALFREDO (MD)
Entity type:Individual
Prefix:DR
First Name:WERNER
Middle Name:ALFREDO
Last Name:ANDRADE ORTIZ
Suffix:
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 1:2801 NW 79TH AVE STE 407
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1174
Mailing Address - Country:US
Mailing Address - Phone:786-320-5022
Mailing Address - Fax:786-320-5088
Practice Address - Street 1:2801 NW 79TH AVE STE 407
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1174
Practice Address - Country:US
Practice Address - Phone:786-320-5022
Practice Address - Fax:786-320-5088
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117468208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ138906OtherPTAN
FL009665200Medicaid
AZ539106Medicaid