Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | F8393 | TX |
NPI | 1023052909 |
---|---|
Provider Name | Charles E Andrews JR. |
First Address | Fort Worth, TX 76104 |
Second Address | Fort Worth, TX 76104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 18/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10014258 | AMERIGROUP (01) | |
118142201 | (05) | TX |
1636207 | (05) | LA |
390002998 | MEDICARE RAILROAD (01) | |
4036866 | AETNA (01) | |
834767 | BLUE CROSS BLUE SHIELD (01) | TX |
C12870 | (02) |