Provider Demographics
NPI:1841220209
Name:ANDREW, JOHN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:ANDREW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:599 SIR FRANCES DRAKE BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1731
Mailing Address - Country:US
Mailing Address - Phone:415-925-1523
Mailing Address - Fax:
Practice Address - Street 1:599 SIR FRANCES DRAKE BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1731
Practice Address - Country:US
Practice Address - Phone:415-925-1523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29437207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA25767Medicare UPIN