Provider Demographics
NPI:1003806837
Name:LANDRY, ROBERT H (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:LANDRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W 4TH ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2448
Mailing Address - Country:US
Mailing Address - Phone:931-528-7877
Mailing Address - Fax:931-526-3261
Practice Address - Street 1:100 W 4TH ST
Practice Address - Street 2:SUITE 310
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2448
Practice Address - Country:US
Practice Address - Phone:931-528-7877
Practice Address - Fax:931-526-3261
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26614207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00373732OtherMEDICARE RAILROAD
TN3090378Medicaid
KY64926199Medicaid
TN3030567OtherBCBST
TN3090378Medicaid
TN3090377Medicare PIN