Provider Demographics
NPI:1083742662
Name:LANDRY, CHRISTINE SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:SUSAN
Last Name:LANDRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 WORTH ST
Mailing Address - Street 2:SUITE 235
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2003
Mailing Address - Country:US
Mailing Address - Phone:214-820-2302
Mailing Address - Fax:214-820-2303
Practice Address - Street 1:3410 WORTH ST
Practice Address - Street 2:SUITE 235
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2003
Practice Address - Country:US
Practice Address - Phone:214-820-2302
Practice Address - Fax:214-820-2303
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9438208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ147350OtherMEDICARE ID (PTAN)
AZZ147350OtherMEDICARE ID (PTAN)