Provider Demographics
NPI:1033111497
Name:LADNER, ANDREW DAVID (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:DAVID
Last Name:LADNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COUNTRY RD E
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF GOLF
Mailing Address - State:FL
Mailing Address - Zip Code:33436-5611
Mailing Address - Country:US
Mailing Address - Phone:561-736-1805
Mailing Address - Fax:561-736-1806
Practice Address - Street 1:1 COUNTRY RD E
Practice Address - Street 2:
Practice Address - City:VILLAGE OF GOLF
Practice Address - State:FL
Practice Address - Zip Code:33436-5611
Practice Address - Country:US
Practice Address - Phone:561-736-1805
Practice Address - Fax:561-736-1806
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0048554207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252510100Medicaid
FL252510100Medicaid
FLD50483Medicare UPIN