Healthcare Provider Details

I. General information

NPI: 1912946278
Provider Name (Legal Business Name): KEVIN JEFFREY LAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 W 14TH ST STE 120
TEMPE AZ
85281-6974
US

IV. Provider business mailing address

28173 RUFFIAN DR
FAIR OAKS TX
78015-4807
US

V. Phone/Fax

Practice location:
  • Phone: 602-343-7201
  • Fax:
Mailing address:
  • Phone: 817-412-5610
  • Fax: 817-412-5991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number46104
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number53404
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License NumberK2163
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License NumberMD488369C
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberK1263
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: