Provider Demographics
NPI:1124052089
Name:ANDRUS, JOHN C (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:ANDRUS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-717-9840
Mailing Address - Fax:405-942-4790
Practice Address - Street 1:5100 N BROOKLINE AVE
Practice Address - Street 2:950
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3623
Practice Address - Country:US
Practice Address - Phone:405-717-9840
Practice Address - Fax:405-942-4790
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2017-07-21
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Provider Licenses
StateLicense IDTaxonomies
OK127712084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100124020AMedicaid
OK100124020AMedicaid