MEDICARE: R ANDREW PACKARD MD

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	207RG0100X	Gastroenterology Physician	ME132264	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C04536	OTHER	MS	MEDICARE GROUP NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942260260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	R ANDREW PACKARD MD

Provider Business Mailing Address
First Line	:	155 KEY HAVEN RD
Second Line	:
City	:	KEY WEST
State	:	FL
Zip	:	33040-6212
Country	:	US
Telephone Number	:	845-532-8687
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 12TH ST STE 205
Second Line	:
City	:	KEY WEST
State	:	FL
Zip	:	33040-3001
Country	:	US
Telephone Number	:	305-294-3458
Fax Number	:	305-294-8432

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	08/15/2019

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Directions to “ R ANDREW PACKARD MD” Practice Location

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