1609013515 NPI number — WILLIAM N. LANDRY, III, MD, APMC

Table of content: (NPI 1609013515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609013515 NPI number — WILLIAM N. LANDRY, III, MD, APMC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM N. LANDRY, III, MD, APMC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1609013515
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 LAKEVIEW DR
Provider Second Line Business Mailing Address:
#100
Provider Business Mailing Address City Name:
COVINGTON
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70433-7511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-898-1940
Provider Business Mailing Address Fax Number:
985-809-0278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 LAKEVIEW DR
Provider Second Line Business Practice Location Address:
#100
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70433-7511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-898-1940
Provider Business Practice Location Address Fax Number:
985-809-0278
Provider Enumeration Date:
01/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LANDRY
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
N
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
985-898-1940

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  017705 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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