Provider Demographics
NPI:1629060280
Name:ANDARY, JOHN L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:ANDARY
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 1:8775 S SADDLE HORN DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-4957
Mailing Address - Country:US
Mailing Address - Phone:208-552-2221
Mailing Address - Fax:
Practice Address - Street 1:2035 E 17TH ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6430
Practice Address - Country:US
Practice Address - Phone:208-524-5633
Practice Address - Fax:208-524-1045
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-8490207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806411300Medicaid
ID50476OtherBLUE CROSS OF IDAHO
ID00001013974OtherREGENCE BLUE SHIELD
ID806411300Medicaid
IDH64951Medicare UPIN