MEDICARE: PHILIP H LANDIS M.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	207R00000X	Internal Medicine Physician	3577	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00253308	OTHER	NV	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	11040930	OTHER		CAQH

General Provider Information

NPI Number	:	1629162649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP H LANDIS M.D.

Provider Business Mailing Address
First Line	:	850 HARVARD WAY
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89502-2055
Country	:	US
Telephone Number	:	775-982-5262
Fax Number	:	775-982-5496

Provider Business Practice Location Address
First Line	:	75 PRINGLE WAY STE 601
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89502-1472
Country	:	US
Telephone Number	:	775-982-5000
Fax Number	:	775-982-3900

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	05/15/2020

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Directions to “ PHILIP H LANDIS M.D.” Practice Location

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