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NPI Code Detail

MEDICARE: SCOTT LANDRY M.D.

MEDICARE: SCOTT LANDRY 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
1207P00000XEmergency Medicine Physician036-103851IL
2207P00000XEmergency Medicine Physician2000155010MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639196272
Entity Type Code : Individual
Provider Name (Legal Business Name) : SCOTT LANDRY M.D.
Provider Business Mailing Address
First Line : 434 N WEST ST
Second Line :
City : PERRYVILLE
State : MO
Zip : 63775-1359
Country : US
Telephone Number : 573-547-2536
Fax Number : 573-519-5347
Provider Business Practice Location Address
First Line : 434 N WEST ST
Second Line :
City : PERRYVILLE
State : MO
Zip : 63775-1359
Country : US
Telephone Number : 573-547-2536
Fax Number : 573-519-5347
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2006
Last Update Date : 11/03/2025

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Directions to “ SCOTT LANDRY M.D.” Practice Location

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