Provider Demographics
NPI:1811915168
Name:GUIDRY, ANDREW MARTIN (DO)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:MARTIN
Last Name:GUIDRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:MARTIN
Other - Last Name:GUIDRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:19 BALD EAGLE DR STE B
Mailing Address - Street 2:
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-3580
Mailing Address - Country:US
Mailing Address - Phone:239-394-4111
Mailing Address - Fax:
Practice Address - Street 1:19 BALD EAGLE DR STE B
Practice Address - Street 2:
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-3580
Practice Address - Country:US
Practice Address - Phone:239-394-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0007068207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57243OtherBLUE CROSS BLUE SHEILD OF FLORIDA
57243AOtherMEDICARE
FL990003533OtherMEDICARE RAILROAD
FLG22420Medicare UPIN