Provider Demographics
NPI:1376528752
Name:LANDES, PHILLIP W (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:W
Last Name:LANDES
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 1:3129 FALLING BRK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4541
Mailing Address - Country:US
Mailing Address - Phone:210-492-3449
Mailing Address - Fax:
Practice Address - Street 1:2701 BABCOCK RD
Practice Address - Street 2:SUITE A
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4800
Practice Address - Country:US
Practice Address - Phone:210-614-3225
Practice Address - Fax:210-614-3231
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2011-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0043013204C00000X, 208100000X, 2081P2900X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine