Provider Demographics
NPI:1942260260
Name:PACKARD, R ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:R
Middle Name:ANDREW
Last Name:PACKARD
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 1:155 KEY HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-6212
Mailing Address - Country:US
Mailing Address - Phone:845-532-8687
Mailing Address - Fax:
Practice Address - Street 1:1111 12TH ST STE 205
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-3001
Practice Address - Country:US
Practice Address - Phone:305-294-3458
Practice Address - Fax:305-294-8432
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME132264207RG0100X
MS19744207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC04536OtherMEDICARE GROUP NUMBER
MSC04536OtherMEDICARE GROUP NUMBER
MS100001465Medicare PIN