1578568432 NPI number — DR. ANDREW R DEEMER MD

Table of content: DR. ANDREW R DEEMER MD (NPI 1578568432)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578568432 NPI number — DR. ANDREW R DEEMER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEEMER
Provider First Name:
ANDREW
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578568432
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/20/2006
NPI Reactivation Date:
03/24/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3998 VISTA WAY
Provider Second Line Business Mailing Address:
STE C200
Provider Business Mailing Address City Name:
OCEANSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92056-4519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-724-5352
Provider Business Mailing Address Fax Number:
760-724-5447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3998 VISTA WAY
Provider Second Line Business Practice Location Address:
STE C200
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92056-4519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-724-5352
Provider Business Practice Location Address Fax Number:
760-724-5447
Provider Enumeration Date:
06/16/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  G66191 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G661910 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".