Provider Demographics
NPI:1861783490
Name:DE ANDRADE, PAULO R (MD)
Entity type:Individual
Prefix:
First Name:PAULO
Middle Name:R
Last Name:DE ANDRADE
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 1:320 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:WAKEENEY
Mailing Address - State:KS
Mailing Address - Zip Code:67672-2002
Mailing Address - Country:US
Mailing Address - Phone:785-743-2182
Mailing Address - Fax:785-743-6317
Practice Address - Street 1:320 N 13TH ST
Practice Address - Street 2:
Practice Address - City:WAKEENEY
Practice Address - State:KS
Practice Address - Zip Code:67672-2002
Practice Address - Country:US
Practice Address - Phone:785-743-2182
Practice Address - Fax:785-743-6317
Is Sole Proprietor?:No
Enumeration Date:2011-04-30
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4153207Q00000X
OK28015207Q00000X
KS04-36496207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine