Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH 12173 | FL |
NPI | 1275818874 |
---|---|
Provider Name | Dr. Lars Landers |
First Address | Port Orange, FL 32127-5169 |
Second Address | Port Orange, FL 32127-5169 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2011 |
Last Update Date | 06/05/2017 |