Provider Demographics
NPI:1235232638
Name:SAW, ANDREW M (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:SAW
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:PO BOX 1028
Mailing Address - Street 2:3003 CENTRAL AVENUE
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68848-1028
Mailing Address - Country:US
Mailing Address - Phone:308-237-2232
Mailing Address - Fax:308-237-2376
Practice Address - Street 1:3003 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-3506
Practice Address - Country:US
Practice Address - Phone:308-237-2232
Practice Address - Fax:308-237-2376
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE184842084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47-074834900Medicaid
090244Medicare PIN
NE47-074834900Medicaid