Provider Demographics
NPI:1104142173
Name:AYUSO, ANDRES A (MD)
Entity type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:A
Last Name:AYUSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1658 ST. VINCENTS WAY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068
Mailing Address - Country:US
Mailing Address - Phone:904-264-1628
Mailing Address - Fax:904-264-8386
Practice Address - Street 1:1658 ST. VINCENTS WAY
Practice Address - Street 2:SUITE 130
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068
Practice Address - Country:US
Practice Address - Phone:904-264-1628
Practice Address - Fax:904-264-8386
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2018-06-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME121426207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology