Provider Demographics
NPI:1871531707
Name:ANDREWS, ANGELIA GAYE (MD)
Entity type:Individual
Prefix:
First Name:ANGELIA
Middle Name:GAYE
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E PECAN ST
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-6141
Mailing Address - Country:US
Mailing Address - Phone:580-379-5000
Mailing Address - Fax:580-379-5509
Practice Address - Street 1:205 S PARK LN
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-5755
Practice Address - Country:US
Practice Address - Phone:580-379-6650
Practice Address - Fax:580-379-6659
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22072207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01103919OtherRAILROAD MEDICARE
OK100113760DMedicaid
P01103919OtherRAILROAD MEDICARE
OKOKAAA1615Medicare PIN