Provider Demographics
NPI:1851603146
Name:EDER, ANDRAS T (MD)
Entity Type:Individual
Prefix:MR
First Name:ANDRAS
Middle Name:T
Last Name:EDER
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:PO BOX 627
Mailing Address - Street 2:
Mailing Address - City:PINEDALE
Mailing Address - State:WY
Mailing Address - Zip Code:82941-0627
Mailing Address - Country:US
Mailing Address - Phone:307-367-4133
Mailing Address - Fax:
Practice Address - Street 1:625 E HENNICK ST
Practice Address - Street 2:
Practice Address - City:PINEDALE
Practice Address - State:WY
Practice Address - Zip Code:82941-5228
Practice Address - Country:US
Practice Address - Phone:307-367-4133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2023-07-06
Deactivation Date:2020-04-16
Deactivation Code:
Reactivation Date:2020-04-21
Provider Licenses
StateLicense IDTaxonomies
IL125.076711207Q00000X
390200000X
WY15696A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program