=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689255374
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN PAUL ANDREW DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2021
-----------------------------------------------------
Last Update Date | 06/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 431 MEADOWLARK ST
-----------------------------------------------------
City | SHAW AFB
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29152-5019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-895-2273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3551 ROGER BROOKE DR
-----------------------------------------------------
City | FORT SAM HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78234-4504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 0102207402
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------