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NPI Code Detail

MEDICARE: DR. BRUCE ROBERT ANDICH MD

MEDICARE: DR. BRUCE ROBERT ANDICH 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
1207R00000XInternal Medicine PhysicianG23109CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100G231090OTHERCAMEDICARE ID-TYPE UNSPECIFIED

General Provider Information

NPI Number : 1982682381
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRUCE ROBERT ANDICH MD
Provider Business Mailing Address
First Line : 88 MADRONE ST
Second Line :
City : WILLITS
State : CA
Zip : 95490-4249
Country : US
Telephone Number : 707-459-6115
Fax Number :
Provider Business Practice Location Address
First Line : 88 MADRONE ST
Second Line :
City : WILLITS
State : CA
Zip : 95490-4249
Country : US
Telephone Number : 707-459-6115
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2006
Last Update Date : 02/15/2011

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Directions to “ DR. BRUCE ROBERT ANDICH MD” Practice Location

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