Provider Demographics
NPI:1194285692
Name:WONDRA, ANDREW CHARLES (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:CHARLES
Last Name:WONDRA
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 1:2151 45TH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2009
Mailing Address - Country:US
Mailing Address - Phone:954-458-1199
Mailing Address - Fax:
Practice Address - Street 1:2151 45TH ST STE 204
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2009
Practice Address - Country:US
Practice Address - Phone:954-458-1199
Practice Address - Fax:877-204-4721
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME167198208VP0014X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine