MEDICARE: DR. DAVID BRUCE LANDERS 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	261QU0200X	Urgent Care Clinic/Center	A26343	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	012565	OTHER	LA	MEDICAL LICENSE
2	A26343	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1174691042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID BRUCE LANDERS M.D.

Provider Business Mailing Address
First Line	:	3364 E SLAUSON AVE
Second Line	:	TECHNIMED
City	:	LOS ANGELES
State	:	CA
Zip	:	90058-3915
Country	:	US
Telephone Number	:	323-585-7242
Fax Number	:	323-584-0059

Provider Business Practice Location Address
First Line	:	3364 E SLAUSON AVE
Second Line	:	TECHNIMED
City	:	LOS ANGELES
State	:	CA
Zip	:	90058-3915
Country	:	US
Telephone Number	:	323-585-7242
Fax Number	:	323-584-0059

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

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	07/08/2007

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