Provider Demographics
NPI:1073550315
Name:LANDMANN, DWIGHT D (MD)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:D
Last Name:LANDMANN
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 1:1541 SW 1ST AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6506
Mailing Address - Country:US
Mailing Address - Phone:352-622-8152
Mailing Address - Fax:352-622-4408
Practice Address - Street 1:1541 SW 1ST AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6506
Practice Address - Country:US
Practice Address - Phone:352-622-8152
Practice Address - Fax:352-622-4408
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059248208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054220200Medicaid
FL020011821OtherMEDICARE RAILROAD
FL12079ZMedicare PIN
FL020011821OtherMEDICARE RAILROAD