MEDICARE: DR. WILLIAM CHRISTOPHER LANDREY DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	E1457	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2500280001	OTHER	CA	DME
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	T10967	OTHER	CA	UPIN

General Provider Information

NPI Number	:	1346257706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM CHRISTOPHER LANDREY DPM

Provider Business Mailing Address
First Line	:	9474 BASELINE RD
Second Line	:
City	:	ALTA LOMA
State	:	CA
Zip	:	91701-5822
Country	:	US
Telephone Number	:	909-987-3211
Fax Number	:	909-987-0317

Provider Business Practice Location Address
First Line	:	9474 BASELINE RD
Second Line	:
City	:	ALTA LOMA
State	:	CA
Zip	:	91701-5822
Country	:	US
Telephone Number	:	909-987-3211
Fax Number	:	909-987-0317

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	11/06/2007

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