Provider Demographics
NPI:1558113662
Name:LANDRY, LAYNE ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:LAYNE
Middle Name:ALLEN
Last Name:LANDRY
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 1:1 SAINT MARY PL
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4307
Mailing Address - Country:US
Mailing Address - Phone:318-675-5379
Mailing Address - Fax:318-675-4671
Practice Address - Street 1:1 SAINT MARY PL
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4307
Practice Address - Country:US
Practice Address - Phone:318-675-5379
Practice Address - Fax:318-675-4671
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program