Provider Demographics
NPI:1093237646
Name:LANDERS, JUDD WILLIAM
Entity Type:Individual
Prefix:
First Name:JUDD
Middle Name:WILLIAM
Last Name:LANDERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5404 NE ANTIOCH RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-2507
Mailing Address - Country:US
Mailing Address - Phone:816-454-5818
Mailing Address - Fax:816-454-5994
Practice Address - Street 1:5404 NE ANTIOCH RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64119-2507
Practice Address - Country:US
Practice Address - Phone:816-454-5818
Practice Address - Fax:816-454-5994
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017024054208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation