Provider Demographics
NPI:1639145121
Name:EANDI, JONATHAN ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ANDREW
Last Name:EANDI
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2725 CAPITOL AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6004
Practice Address - Country:US
Practice Address - Phone:916-262-9386
Practice Address - Fax:916-262-9391
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2015-05-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA84755208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA84755OtherMEDICAL LICENSE