Provider Demographics
NPI:1053307975
Name:PAINTER, ANDREW ERNEST (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:ERNEST
Last Name:PAINTER
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 1:204 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63873-1402
Mailing Address - Country:US
Mailing Address - Phone:573-379-5467
Mailing Address - Fax:573-379-5671
Practice Address - Street 1:204 E 3RD ST
Practice Address - Street 2:
Practice Address - City:PORTAGEVILLE
Practice Address - State:MO
Practice Address - Zip Code:63873-1402
Practice Address - Country:US
Practice Address - Phone:573-379-5467
Practice Address - Fax:573-379-5671
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1370207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A11359Medicare UPIN