Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | R3897 | TX |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | R3897 | TX |
NPI | 1427468453 |
---|---|
Provider Name | Matthew Landrum |
First Address | San Antonio, TX 78229-3931 |
Second Address | San Antonio, TX 78229-3931 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2014 |
Last Update Date | 18/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
411710301 | (05) | TX |
411710302 | CSHCN (01) | TX |