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General NPI Number Information
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NPI Number | 1487608287
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Entity Type | Individual
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Provider Name | PATRICIA A LANDRY M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 02/27/2013
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Provider Practice Location Address
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Address Line | 309 E 1ST AVE
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City | EASLEY
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State | SC
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Zip | 29640-3040
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Country | US
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Telephone | 864-859-6331
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Fax | 864-855-1045
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Provider Business Mailing Address
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Address Line | PO BOX 2089
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City | EASLEY
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State | SC
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Zip | 29641-2089
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Country | US
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Telephone | 864-855-5104
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Fax | 864-859-9362
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 16015
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License Number State | SC
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