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Individual
CARL RYAN ANDRUS
Active
Individual
CARL RYAN ANDRUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-508
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010157032
BLUE CROSS
ID
01
—
000010157033
BLUE SHIELD
ID
05
—
807520000
—
ID
01
—
PAD25
BLUE CROSS
ID
01
—
PAD26
BLUE CROSS
ID
Enumeration date
08/13/2006
Last updated
07/08/2007
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