Provider Demographics
NPI:1427832500
Name:RUTHERFORD, ANDREW BLAKE
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:BLAKE
Last Name:RUTHERFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N PALAFOX ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-2664
Mailing Address - Country:US
Mailing Address - Phone:800-210-0814
Mailing Address - Fax:
Practice Address - Street 1:1300 N PALAFOX ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-2664
Practice Address - Country:US
Practice Address - Phone:800-210-0814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician