Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | N3810 | TX |
Y | 207QS0010X | Family Doctor - Sports Medicine | 3862 | OK |
N | 207QS0010X | Family Doctor - Sports Medicine | N3810 | TX |
N | 207X00000X | Orthopaedic Surgeon | N3810 | TX |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 19051 | MS |
NPI | 1033223730 |
---|---|
Provider Name | Michael D Landers |
First Address | Tulsa, OK 74136-3331 |
Second Address | Tulsa, OK 74133-5515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 29/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
06008071 | (05) | MS |
1418153 | (05) | LA |
3442570 | AMERICAN ADMIN GROUP (01) | MS |
8CG326 | BCBS (01) | TX |
I06815 | (02) | |
P00308321 | RAILROAD MEDICARE (01) |