Provider Demographics
NPI:1609013515
Name:WILLIAM N. LANDRY, III, MD, APMC
Entity Type:Organization
Organization Name:WILLIAM N. LANDRY, III, MD, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:N
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:985-898-1940
Mailing Address - Street 1:110 LAKEVIEW DR
Mailing Address - Street 2:#100
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7511
Mailing Address - Country:US
Mailing Address - Phone:985-898-1940
Mailing Address - Fax:985-809-0278
Practice Address - Street 1:110 LAKEVIEW DR
Practice Address - Street 2:#100
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7511
Practice Address - Country:US
Practice Address - Phone:985-898-1940
Practice Address - Fax:985-809-0278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017705174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D04255Medicare UPIN
LA54952Medicare PIN