Individual
AEDRA D. ANDRADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
610 N 5TH ST, GALLUP, NM 87301-5306
(505) 863-3120
(505) 863-2691
Mailing address
1504 FAIRWAY CIR, GALLUP, NM 87301-4937
(505) 722-5008
(505) 722-5008
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
NM2003-0155
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16657055
—
NM
Enumeration date
08/14/2006
Last updated
08/01/2023
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