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NPI Code Detail

MEDICARE: MARY ALEXANDRA LANDRY PA-C

MEDICARE: MARY ALEXANDRA LANDRY PA-C
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
1363A00000XPhysician AssistantPA04319TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PA04319OTHERTXMEDICAL LICENSE

General Provider Information

NPI Number : 1609109552
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ALEXANDRA LANDRY PA-C
Provider Business Mailing Address
First Line : 300 E JOHN CARPENTER FWY
Second Line : SUITE 850
City : IRVING
State : TX
Zip : 75062-2727
Country : US
Telephone Number : 972-957-3000
Fax Number : 972-957-3005
Provider Business Practice Location Address
First Line : 8112 SPRING VALLEY RD
Second Line :
City : DALLAS
State : TX
Zip : 75240-3829
Country : US
Telephone Number : 214-884-1705
Fax Number : 214-884-1711
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2009
Last Update Date : 01/28/2011

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Directions to “ MARY ALEXANDRA LANDRY PA-C” Practice Location

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