Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ME88713 | FL |
Y | 2084N0402X | Child Neurologist | ME88713 | FL |
NPI | 1013023399 |
---|---|
Provider Name | Dr. Edgard Olbany Andrade |
First Address | Ocala, FL 34471-1022 |
Second Address | Ocala, FL 34471-1022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
276415600 | (05) | FL |
I63401 | (02) |