Provider Demographics
NPI:1093754665
Name:PERRY, LANDON S (MD)
Entity Type:Individual
Prefix:DR
First Name:LANDON
Middle Name:S
Last Name:PERRY
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 1:6300 W PARKER RD
Mailing Address - Street 2:SUITE 427
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8100
Mailing Address - Country:US
Mailing Address - Phone:972-981-7940
Mailing Address - Fax:972-981-7941
Practice Address - Street 1:6300 W PARKER RD
Practice Address - Street 2:SUITE 427
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8100
Practice Address - Country:US
Practice Address - Phone:972-981-7940
Practice Address - Fax:972-981-7941
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6572208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167221401Medicaid
TX167221401Medicaid
613537Medicare PIN