MEDICARE: DR. RICHARD E. LAND D.O.

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	2084P0800X	Psychiatry Physician	20A3171	CA

General Provider Information

NPI Number	:	1497880017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD E. LAND D.O.

Provider Business Mailing Address
First Line	:	5151 N PALM AVE STE 400
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93704-2208
Country	:	US
Telephone Number	:	559-225-9092
Fax Number	:	559-225-2275

Provider Business Practice Location Address
First Line	:	5151 N PALM AVE STE 400
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93704-2208
Country	:	US
Telephone Number	:	559-225-9092
Fax Number	:	559-225-2275

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	07/08/2007

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