Doctor Name: | DR. EFIONG OKON ANDEM |
NPI Number: | 1558408997 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | ME30956 |
Business Practice Address: | 4182 Baltzell St Marianna, FL - 324468262 |
Business Phone Number: | 8504827149 |
Business Fax Number: | 8504827149 |
Mailing Address: | 4182 Baltzell Street, Po Box 796 MARIANNA |
State: | FL |
Postal Code: | 32446 |
Phone Number: | 8504827149 |
Fax Number: | 8504827149 |
NPI Enumeration Date: | 02/01/2007 |
NPI Last Update Date: | 06/12/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | ME30956 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |