Healthcare Provider Details

I. General information

NPI: 1205638285
Provider Name (Legal Business Name): JERRY OLIVER ANDREWS II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 SUGAR MAPLE DR # OH45433
WPAFB OH
45433-5529
US

IV. Provider business mailing address

4881 SUGAR MAPLE DR WPAFB
DAYTON OH
45433
US

V. Phone/Fax

Practice location:
  • Phone: 937-257-9926
  • Fax:
Mailing address:
  • Phone: 937-257-9926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number8554928
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: