Provider Demographics
NPI:1891716023
Name:DE MAR, ANDREW RICHARD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:RICHARD
Last Name:DE MAR
Suffix:JR
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:PO BOX 2366
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-8366
Mailing Address - Country:US
Mailing Address - Phone:916-797-7534
Mailing Address - Fax:916-797-4712
Practice Address - Street 1:2 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 275
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3043
Practice Address - Country:US
Practice Address - Phone:916-797-7534
Practice Address - Fax:916-797-4712
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58869208600000X, 2086S0102X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G588690Medicare ID - Type Unspecified
CAE32611Medicare UPIN