MEDICARE: DR. LOUIS JAMES LAND M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	MD-12527	HI
2	2084P0804X	Child & Adolescent Psychiatry Physician	66870	CO

General Provider Information

NPI Number	:	1144210154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUIS JAMES LAND M.D.

Provider Business Mailing Address
First Line	:	90 S CASCADE AVE STE 1410
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-1680
Country	:	US
Telephone Number	:	719-285-0562
Fax Number	:

Provider Business Practice Location Address
First Line	:	90 S CASCADE AVE STE 1410
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-1680
Country	:	US
Telephone Number	:	719-285-0562
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	12/23/2021

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