Provider Demographics
NPI:1275617912
Name:LANDRIGAN, JOHN W JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:LANDRIGAN
Suffix:JR
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 1:5180 PARK AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3521
Mailing Address - Country:US
Mailing Address - Phone:901-761-2703
Mailing Address - Fax:901-680-9705
Practice Address - Street 1:5180 PARK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3521
Practice Address - Country:US
Practice Address - Phone:901-761-2703
Practice Address - Fax:901-680-9705
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN008125174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2004169OtherBCBS
TNB03041Medicare UPIN
TN2004169OtherBCBS