1508838814 NPI number — DR. WILSON H LANDERS JR. M.D.

Table of content: DR. WILSON H LANDERS JR. M.D. (NPI 1508838814)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508838814 NPI number — DR. WILSON H LANDERS JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANDERS
Provider First Name:
WILSON
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508838814
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 MEDICAL DRIVE
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
BORGER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79007-7579
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-467-5894
Provider Business Mailing Address Fax Number:
806-274-9520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 MEDICAL DRIVE
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
BORGER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79007-7579
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-467-5894
Provider Business Practice Location Address Fax Number:
806-274-9520
Provider Enumeration Date:
02/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207XX0005X , with the licence number:  F1728 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: F1728 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: Y0035665 . This is a "DPS NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com