Provider Demographics
NPI:1376561886
Name:ANDRE VENDRYES MD PA
Entity Type:Organization
Organization Name:ANDRE VENDRYES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:G
Authorized Official - Last Name:VENDRYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-299-3690
Mailing Address - Street 1:3850 20TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-2472
Mailing Address - Country:US
Mailing Address - Phone:772-299-3690
Mailing Address - Fax:772-299-3680
Practice Address - Street 1:3850 20TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-2472
Practice Address - Country:US
Practice Address - Phone:772-299-3690
Practice Address - Fax:772-299-3680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0076203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44558OtherBLUE CROSS BLUE SHIELD FL
FLDD1359OtherMEDICARE RAILROAD
FLDD1359OtherMEDICARE RAILROAD
FLK7249Medicare PIN