Healthcare Provider Details

I. General information

NPI: 1487238879
Provider Name (Legal Business Name): ANDREW MARTIN CARRIMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 05/11/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF VETRANS AFFAIRS 1601 SW ARCHER ROAD
GAINESVILLE FL
32608
US

IV. Provider business mailing address

8601 VINEYARD RIDGE RD NE
ALBUQUERQUE NM
87122-2623
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-1611
  • Fax:
Mailing address:
  • Phone: 415-317-7108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberTN52570
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: