Provider Demographics
NPI:1477626810
Name:LANDAN, DEREK (MD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:LANDAN
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 1:15560 N FRANK LLOYD WRIGHT BLVD
Mailing Address - Street 2:STE B4 BOX 415
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2091
Mailing Address - Country:US
Mailing Address - Phone:602-787-1231
Mailing Address - Fax:602-787-0021
Practice Address - Street 1:14301 N 87TH ST
Practice Address - Street 2:STE308
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3686
Practice Address - Country:US
Practice Address - Phone:602-787-1231
Practice Address - Fax:602-787-0021
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ28634207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ76849Medicare PIN
H33249Medicare UPIN