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General NPI Number Information
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NPI Number | 1245553023
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Entity Type | Organization
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Legal Business Name | PHILIP A LANDRY MD A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 03/08/2010
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Last Update Date | 09/15/2022
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Provider Practice Location Address
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Address Line | 216 ROBIN LN
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City | OPELOUSAS
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State | LA
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Zip | 70570-9149
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Country | US
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Telephone | 337-942-5815
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Fax | 337-942-8004
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Provider Business Mailing Address
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Address Line | PO BOX 880
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City | OPELOUSAS
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State | LA
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Zip | 70571-0880
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Country | US
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Telephone | 337-942-5815
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Fax | 337-942-8004
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Authorized Official
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Title or Position | OWNER
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Name | PHILIP A, LANDRY
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Credential | MD
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Telephone | 337-942-5815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 012300
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License Number State | LA
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