Provider Demographics
NPI:1144739491
Name:DOORN, ANDREW (PA-C)
Entity Type:Individual
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First Name:ANDREW
Middle Name:
Last Name:DOORN
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:4351 E LOHMAN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8260
Mailing Address - Country:US
Mailing Address - Phone:575-522-4940
Mailing Address - Fax:575-522-4932
Practice Address - Street 1:1105 SIXTH ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2345
Practice Address - Country:US
Practice Address - Phone:231-935-7514
Practice Address - Fax:231-392-0039
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2024-02-28
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Provider Licenses
StateLicense IDTaxonomies
NMPA2017-0088363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant