Healthcare Provider Details

I. General information

NPI: 1891788022
Provider Name (Legal Business Name): JEFFREY H LANDAU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
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 W ELDORADO PKWY SUITE 102 PMB 901
MCKINNEY TX
75070-6309
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 TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number77084
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberG50587
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberK4934
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: