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NPI Code Detail

MEDICARE: LAYNE ALLEN LANDRY MD

MEDICARE: LAYNE ALLEN LANDRY MD
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1558113662
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAYNE ALLEN LANDRY MD
Provider Business Mailing Address
First Line : 1 SAINT MARY PL
Second Line :
City : SHREVEPORT
State : LA
Zip : 71101-4307
Country : US
Telephone Number : 318-675-5379
Fax Number : 318-675-4671
Provider Business Practice Location Address
First Line : 1 SAINT MARY PL
Second Line :
City : SHREVEPORT
State : LA
Zip : 71101-4307
Country : US
Telephone Number : 318-675-5379
Fax Number : 318-675-4671
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2024
Last Update Date : 04/02/2024

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