Basic Information
| Provider Information | |||||||||
| NPI: | 1679558852 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YANG | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 E. HIGHWAY 20 | ||||||||
| Address2: | FAMILY MEDICINE DEPARTMENT | ||||||||
| City: | NICEVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325786707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508974400 | ||||||||
| FaxNumber: | 8508970623 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 E HIGHWAY 20 | ||||||||
| Address2: | FAMILY PRACTICE DEPARTMENT | ||||||||
| City: | NICEVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325788826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508974400 | ||||||||
| FaxNumber: | 8508970623 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2005 | ||||||||
| LastUpdateDate: | 01/20/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME83436 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 267191300 | 05 | FL | MEDICAID | 29233 | 01 | FL | BCBSFL | OTHER |