Provider Demographics
NPI:1508891516
Name:ANDERSON, LANDON B (MD)
Entity Type:Individual
Prefix:
First Name:LANDON
Middle Name:B
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:300 MEDICAL AVE STE 1
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420
Mailing Address - Country:US
Mailing Address - Phone:334-427-1022
Mailing Address - Fax:334-427-1023
Practice Address - Street 1:300 MEDICAL AVE
Practice Address - Street 2:STE 1
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420
Practice Address - Country:US
Practice Address - Phone:334-427-1022
Practice Address - Fax:334-427-1023
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL25193207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C81579Medicare UPIN