Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 26614 | TN |
NPI | 1003806837 |
---|---|
Provider Name | Dr. Robert H Landry |
First Address | Cookeville, TN 38501-2448 |
Second Address | Cookeville, TN 38501-2448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 13/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3030567 | BCBST (01) | TN |
3090378 | (05) | TN |
64926199 | (05) | KY |
G18079 | (02) | |
P00373732 | MEDICARE RAILROAD (01) | TN |