Provider Demographics
NPI:1154352573
Name:ANDRUS, KENNETH LEWIS (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:LEWIS
Last Name:ANDRUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 VETERANS AVE
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2410
Mailing Address - Country:US
Mailing Address - Phone:850-471-7779
Mailing Address - Fax:850-471-7702
Practice Address - Street 1:6425 PENSACOLA BLVD
Practice Address - Street 2:OFFICE PARK PLAZA SUITE 1
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-1701
Practice Address - Country:US
Practice Address - Phone:850-471-7779
Practice Address - Fax:850-471-7702
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72955174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist