MEDICARE: DR. JOHN R ANDRUS M.D., MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083A0100X	Aerospace Medicine Physician	01052709A	IN

General Provider Information

NPI Number	:	1205813284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN R ANDRUS M.D., MPH

Provider Business Mailing Address
First Line	:	690 BARNES BLVD
Second Line	:
City	:	MCCHORD AFB
State	:	WA
Zip	:	98438-1303
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	690 BARNES BLVD
Second Line	:
City	:	MCCHORD AFB
State	:	WA
Zip	:	98438-1303
Country	:	US
Telephone Number	:	253-982-5688
Fax Number	:	253-982-0332

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	07/08/2007

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