=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588744387
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW HAMILTON FLETCHER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 SW ARCHER RD, ROOM 3109 SHANDS HEALTHCARE - SURGICAL PATHOLOGY
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-265-0111
-----------------------------------------------------
Fax | 352-265-0437
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5269 SW 97TH DR
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32608-4153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number | TRN6873
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------