Healthcare Provider Details

I. General information

NPI: 1033554498
Provider Name (Legal Business Name): MATTHEW JOHN LANDHERR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 1ST AVE SE STE 200
CEDAR RAPIDS IA
52402-5417
US

IV. Provider business mailing address

1815 1ST AVE SE STE 200
CEDAR RAPIDS IA
52402-5417
US

V. Phone/Fax

Practice location:
  • Phone: 319-363-0474
  • Fax: 319-363-2170
Mailing address:
  • Phone: 319-363-0474
  • Fax: 319-363-2170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD-42827
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD-42827
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: