Healthcare Provider Details

I. General information

NPI: 1548235146
Provider Name (Legal Business Name): JONATHAN C LANDSMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19636 N 27TH AVE STE 401
PHOENIX AZ
85027-4021
US

IV. Provider business mailing address

19636 N 27TH AVE STE 401
PHOENIX AZ
85027-4021
US

V. Phone/Fax

Practice location:
  • Phone: 602-298-8888
  • Fax: 602-978-4129
Mailing address:
  • Phone: 602-298-8888
  • Fax: 602-978-4129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number26815
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: