1235372368 NPI number — ANDREW PHILLIP DEWOLFE M.D.

Table of content: ANDREW PHILLIP DEWOLFE M.D. (NPI 1235372368)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235372368 NPI number — ANDREW PHILLIP DEWOLFE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEWOLFE
Provider First Name:
ANDREW
Provider Middle Name:
PHILLIP
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235372368
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
455 PINELLAS ST
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33756-3354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-445-1911
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1840 MEASE DR
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
SAFETY HARBOR
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34695-6602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-725-6246
Provider Business Practice Location Address Fax Number:
727-726-5865
Provider Enumeration Date:
04/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  ME123778 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ME123778 . This is a "FLORIDA BOARD OF MEDICINE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: IE953Z . This is a "MEDICARE PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 015114700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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