Provider Demographics
NPI:1639382088
Name:ROGER N ANDREWS MD INC
Entity Type:Organization
Organization Name:ROGER N ANDREWS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:N
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-446-8595
Mailing Address - Street 1:624 W DUARTE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7603
Mailing Address - Country:US
Mailing Address - Phone:626-446-8595
Mailing Address - Fax:626-446-1031
Practice Address - Street 1:624 W DUARTE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7603
Practice Address - Country:US
Practice Address - Phone:626-446-8595
Practice Address - Fax:626-446-1031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31944174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G319440Medicaid
CA00G319440Medicaid
CAW21613Medicare PIN