Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | M9438 | TX |
Y | 208600000X | Surgeon | M9438 | TX |
N | 2086X0206X | Surgical Oncologist | M9438 | TX |
NPI | 1083742662 |
---|---|
Provider Name | Dr. Christine Susan Landry |
First Address | Dallas, TX 75246-2003 |
Second Address | Dallas, TX 75246-2003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 14/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Z147350 | MEDICARE ID (PTAN) (01) | AZ |