Provider Demographics
NPI:1669469326
Name:BOEZAART, ANDRE PIERRE (MD PHD)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:PIERRE
Last Name:BOEZAART
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-392-3441
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-392-3441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IASP130207L00000X, 207LP2900X
FLMFC1619207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0239749Medicaid
IA28602OtherWELLMARK BCBS
FL279611200Medicaid
AI040ZMedicare PIN
IA0239749Medicaid
IAI2012Medicare ID - Type Unspecified