Healthcare Provider Details

I. General information

NPI: 1073584900
Provider Name (Legal Business Name): ANDREW JACKSON SELLERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4473 N SADDLE DR
BEVERLY HILLS FL
34465-4855
US

IV. Provider business mailing address

4040 E CAMELBACK RD STE 250
PHOENIX AZ
85018-8350
US

V. Phone/Fax

Practice location:
  • Phone: 855-687-7237
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number209761
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number229371
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME136121
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101241822
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: