Provider Demographics
NPI:1215021050
Name:AZIZ, ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:AZIZ
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 1:331 N MAITLAND AVE STE B2
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4753
Mailing Address - Country:US
Mailing Address - Phone:407-740-0331
Mailing Address - Fax:407-539-2747
Practice Address - Street 1:331 N MAITLAND AVE
Practice Address - Street 2:STE B2
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4762
Practice Address - Country:US
Practice Address - Phone:407-740-0331
Practice Address - Fax:407-539-2747
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91237207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL72948OtherBLUE CROSS BLUE SHIELD
FL72948OtherMEDICARE PTAN
FL96809OtherBLUE CROSS BLUE SHIELD
FL004055848OtherAETNA
FL4946331OtherCIGNA
FLP00647574OtherRAILROAD MEDICARE
FLP00647574OtherRAILROAD MEDICARE
FLG35157Medicare UPIN