Provider Demographics
NPI:1689624652
Name:ANDRUS, DAN L (MD)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:L
Last Name:ANDRUS
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 1:72780 COUNTRY CLUB DR STE 203
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4150
Mailing Address - Country:US
Mailing Address - Phone:760-834-3593
Mailing Address - Fax:760-674-3845
Practice Address - Street 1:72780 COUNTRY CLUB DR STE 203
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4150
Practice Address - Country:US
Practice Address - Phone:760-834-3593
Practice Address - Fax:760-674-3845
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31470207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ209701Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
CAA26496Medicare UPIN
CA00A314701Medicare ID - Type Unspecified