Provider Demographics
NPI:1972795599
Name:ENDARA-BRAVO, ANDRES SANTIAGO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:SANTIAGO
Last Name:ENDARA-BRAVO
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 947381
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-7381
Mailing Address - Country:US
Mailing Address - Phone:386-231-4351
Mailing Address - Fax:386-231-4352
Practice Address - Street 1:305 MEMORIAL MEDICAL PKWY STE 307
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5169
Practice Address - Country:US
Practice Address - Phone:386-231-4351
Practice Address - Fax:386-231-4352
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-00560207RP1001X
FLME112358207RS0012X
FLME130498207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME112358OtherSTATE LICENSE
TXS6608OtherMEDICAL LICENSE
NC2015-00560OtherMEDICAL LICENSE