Provider Demographics
NPI:1275786535
Name:LANDER COMPREHENSIVE UROLOGY
Entity Type:Organization
Organization Name:LANDER COMPREHENSIVE UROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:B
Authorized Official - Last Name:LANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-776-0040
Mailing Address - Street 1:72780 COUNTRY CLUB DR
Mailing Address - Street 2:301
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4126
Mailing Address - Country:US
Mailing Address - Phone:760-776-0040
Mailing Address - Fax:760-776-0041
Practice Address - Street 1:72780 COUNTRY CLUB DR
Practice Address - Street 2:301
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4126
Practice Address - Country:US
Practice Address - Phone:760-776-0040
Practice Address - Fax:760-776-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG624900208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF11649Medicare UPIN