Healthcare Provider Details

I. General information

NPI: 1003854696
Provider Name (Legal Business Name): GINA L LAND M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 EASTERN BYPASS BUILDING 2, SUITE 5
RICHMOND KY
40475-2406
US

IV. Provider business mailing address

795 EASTERN BYPASS BUILDING 2, SUITE 5
RICHMOND KY
40475-2406
US

V. Phone/Fax

Practice location:
  • Phone: 859-624-2229
  • Fax: 859-625-9458
Mailing address:
  • Phone: 859-624-2229
  • Fax: 859-625-9458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number30567
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: