Provider Demographics
NPI:1982354510
Name:ANTES, ANDREW WARD (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:WARD
Last Name:ANTES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:528 CAPITOLA AVE
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2750
Mailing Address - Country:US
Mailing Address - Phone:831-475-1630
Mailing Address - Fax:831-475-1629
Practice Address - Street 1:528 CAPITOLA AVE
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2750
Practice Address - Country:US
Practice Address - Phone:831-475-1630
Practice Address - Fax:831-475-1629
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-26
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA191525207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program