Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | D0043013 | MD |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | D0043013 | MD |
N | 2081P2900X | Pain Medicine | D0043013 | MD |
N | 2081S0010X | Sports Medicine | D0043013 | MD |
N | 213ES0000X | Sports Medicine | D0043013 | MD |
NPI | 1376528752 |
---|---|
Provider Name | Dr. Phillip W Landes |
First Address | San Antonio, TX 78258-4541 |
Second Address | San Antonio, TX 78229-4800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2005 |
Last Update Date | 27/02/2011 |