MEDICARE: SUSAN LANDRY PH.D.

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	2080P0006X	Developmental - Behavioral Pediatrics Physician	23461	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	86449A	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1598701054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN LANDRY PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 201088
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77216-1088
Country	:	US
Telephone Number	:	713-500-3500
Fax Number	:	713-500-5484

Provider Business Practice Location Address
First Line	:	7000 FANNIN ST
Second Line	:	2401
City	:	HOUSTON
State	:	TX
Zip	:	77030-5400
Country	:	US
Telephone Number	:	713-500-5700
Fax Number	:	713-500-5711

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	07/08/2007

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Directions to “ SUSAN LANDRY PH.D.” Practice Location

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