Provider Demographics
NPI:1679558852
Name:YANG, ANDREW M (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:YANG
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 1:2001 E. HIGHWAY 20
Mailing Address - Street 2:FAMILY MEDICINE DEPARTMENT
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-6707
Mailing Address - Country:US
Mailing Address - Phone:850-897-4400
Mailing Address - Fax:850-897-0623
Practice Address - Street 1:2001 E HIGHWAY 20
Practice Address - Street 2:FAMILY PRACTICE DEPARTMENT
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-8826
Practice Address - Country:US
Practice Address - Phone:850-897-4400
Practice Address - Fax:850-897-0623
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83436207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267191300Medicaid
FL29233OtherBCBSFL
FLE7263YMedicare PIN
FL29233OtherBCBSFL