Provider Demographics
NPI:1821199316
Name:ANDREW, THOMAS TODD (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:TODD
Last Name:ANDREW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1908 LINDEN CIR
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5338
Mailing Address - Country:US
Mailing Address - Phone:307-685-0020
Mailing Address - Fax:
Practice Address - Street 1:1301 W 3RD ST
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3335
Practice Address - Country:US
Practice Address - Phone:307-682-4551
Practice Address - Fax:307-685-7134
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5717A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYG16416Medicare UPIN