Provider Demographics
NPI:1003861816
Name:LANDY, DAVID JON (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JON
Last Name:LANDY
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 1:1 INDEPENDENCE PLAZA
Mailing Address - Street 2:SUITE 900
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-2643
Mailing Address - Country:US
Mailing Address - Phone:205-271-8000
Mailing Address - Fax:205-879-0548
Practice Address - Street 1:1 INDEPENDENCE PLAZA
Practice Address - Street 2:SUITE 900
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-2643
Practice Address - Country:US
Practice Address - Phone:205-271-8000
Practice Address - Fax:205-879-0548
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00023233207RG0100X
AL23233207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51093462OtherBLUE CROSS PROVIDER NUMBE
AL538800240Medicaid
AL000093462Medicaid
AL2911000OtherUNITED HEALTHCARE PROVIDE
23233OtherMEDICAL STATE LICENSE
ALG01858OtherHEALTHSPRINGS PROVIDER NU
AL000093462Medicare ID - Type UnspecifiedPROVIDER NUMBER
AL000093462Medicaid
AL000093462Medicare PIN