Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0100X | Gastroenterologist | 00023233 | AL |
Y | 207RG0100X | Gastroenterologist | 23233 | AL |
NPI | 1003861816 |
---|---|
Provider Name | Mr. David Jon Landy |
First Address | Birmingham, AL 35209-2643 |
Second Address | Birmingham, AL 35209-2643 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 05/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000093462 | (05) | AL |
23233 | MEDICAL STATE LICENSE (01) | |
2911000 | UNITED HEALTHCARE PROVIDE (01) | AL |
51093462 | BLUE CROSS PROVIDER NUMBE (01) | AL |
538800240 | (05) | AL |
G01858 | (02) | AL |
G01858 | HEALTHSPRINGS PROVIDER NU (01) | AL |