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NPI Code Detail

MEDICARE: DR. RICKEY ELLIS LANDON M.D.

MEDICARE: DR. RICKEY ELLIS LANDON 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
1207L00000XAnesthesiology PhysicianME39193FL

General Provider Information

NPI Number : 1841214855
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICKEY ELLIS LANDON M.D.
Provider Business Mailing Address
First Line : PO BOX 100371
Second Line :
City : GAINESVILLE
State : FL
Zip : 32610-0371
Country : US
Telephone Number : 352-338-2195
Fax Number : 352-265-6027
Provider Business Practice Location Address
First Line : 368 NE FRANKLIN ST
Second Line :
City : LAKE CITY
State : FL
Zip : 32055-3088
Country : US
Telephone Number : 386-754-8120
Fax Number : 904-754-8121
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 07/08/2007

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