Provider Demographics
NPI:1386872042
Name:JOSE ANDRADE MD PA
Entity type:Organization
Organization Name:JOSE ANDRADE MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-658-7882
Mailing Address - Street 1:5412 CURRY FORD RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-8522
Mailing Address - Country:US
Mailing Address - Phone:407-658-7882
Mailing Address - Fax:407-658-7995
Practice Address - Street 1:5412 CURRY FORD RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-8522
Practice Address - Country:US
Practice Address - Phone:407-658-7882
Practice Address - Fax:407-658-7995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0049328207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18251OtherWELLCARE
FL003495300Medicaid
142941OtherONE HEALTH PLAN
FL18251OtherHEALTHESE
FL624969OtherAETNA
03722OtherBCBS
FL0110451OtherGHI
02363OtherUNIVERSAL HEALTH
FL11416701OtherCITRUS
FL47817071-008OtherCIGNA
FL201227OtherAMERIGROUP
142941OtherOHP
03722OtherBCBS