Provider Demographics
NPI:1295710556
Name:KORTZ, ANDREW E (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:E
Last Name:KORTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4570 ISABELLA INGRAM DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-5026
Mailing Address - Country:US
Mailing Address - Phone:850-438-6555
Mailing Address - Fax:850-438-6559
Practice Address - Street 1:4570 ISABELLA INGRAM DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-5026
Practice Address - Country:US
Practice Address - Phone:850-438-6555
Practice Address - Fax:850-438-6559
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63899207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265779100Medicaid
FLP00113272OtherMEDICARE RAILROAD
FLC179OtherHEALTH FIRST NETWORK
AL009940855Medicaid
AL591-68722OtherBLUE CROSS BLUE SHIELD
FL62923OtherBLUE CROSS BLUE SHIELD
AL009940855Medicaid
FL62923YMedicare PIN