Individual
DR. JOHN L ANDARY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2035 E 17TH ST, IDAHO FALLS, ID 83404-6430
(208) 524-5633
(208) 524-1045
Mailing address
8775 S SADDLE HORN DR, IDAHO FALLS, ID 83404-4957
(208) 552-2221
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
M-8490
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00001013974
REGENCE BLUE SHIELD
ID
01
—
50476
BLUE CROSS OF IDAHO
ID
05
—
806411300
—
ID
Enumeration date
08/19/2005
Last updated
09/11/2014
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