Provider Demographics
NPI:1730164096
Name:ANDREW KORTZ MD PA
Entity type:Organization
Organization Name:ANDREW KORTZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:E
Authorized Official - Last Name:KORTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-932-2000
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265779100Medicaid
AL529918320Medicaid
FLDB5369OtherMEDICARE RAILROAD
FL265779100Medicaid