Provider Demographics
NPI:1174696504
Name:ANDREWS, RUSSELL JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:JOSEPH
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:244 MISTLETOE RD
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1610
Mailing Address - Country:US
Mailing Address - Phone:408-829-1700
Mailing Address - Fax:408-353-0275
Practice Address - Street 1:244 MISTLETOE RD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1610
Practice Address - Country:US
Practice Address - Phone:408-829-1700
Practice Address - Fax:408-353-0275
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG46747207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G467471Medicare ID - Type Unspecified
CAA50486Medicare UPIN