Healthcare Provider Details

I. General information

NPI: 1588770051
Provider Name (Legal Business Name): DAVID E ANDRUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/11/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 MDG, UNIT 3215 RAMSTEIN AB
APO AE
09094
US

IV. Provider business mailing address

86 MDG, UNIT 3215 RAMSTEIN AB
APO AE
09094
US

V. Phone/Fax

Practice location:
  • Phone: 314-479-2609
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number42291
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number42291-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: