Healthcare Provider Details

I. General information

NPI: 1134317399
Provider Name (Legal Business Name): JEFFREY H LANDAU MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 CENTRAL EXPY N SUITE 350
ALLEN TX
75013-6103
US

IV. Provider business mailing address

5100 ELDORADO PKWY SUITE 102-PMB 901
MCKINNEY TX
75070
US

V. Phone/Fax

Practice location:
  • Phone: 972-747-4200
  • Fax:
Mailing address:
  • Phone: 972-747-4200
  • Fax: 972-747-4222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberK4934
License Number StateTX

VIII. Authorized Official

Name: JEFFREY H LANDAU
Title or Position: PRESIDENT
Credential: MD
Phone: 972-747-4200