Healthcare Provider Details

I. General information

NPI: 1659051076
Provider Name (Legal Business Name): ANDREW T ANDOYO AA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 GLENN HENDREN DR
LIBERTY MO
64068-9625
US

IV. Provider business mailing address

PO BOX 804408
KANSAS CITY MO
64180-4408
US

V. Phone/Fax

Practice location:
  • Phone: 816-792-7037
  • Fax: 816-792-7196
Mailing address:
  • Phone: 913-647-4100
  • Fax: 913-647-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number2023033233
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: