Provider Demographics
NPI:1568656940
Name:RUTHERFORD, ANDREW L (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:L
Last Name:RUTHERFORD
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 1:16404 SWAN VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-4938
Mailing Address - Country:US
Mailing Address - Phone:813-753-7340
Mailing Address - Fax:
Practice Address - Street 1:16404 SWAN VIEW CIR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-4938
Practice Address - Country:US
Practice Address - Phone:813-753-7340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98900207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME98900OtherMEDICAL LICENSE
FL000675900Medicaid
FL17495OtherBCBS
FLME98900OtherMEDICAL LICENSE
FLBA588UMedicare PIN