Provider Demographics
NPI:1609080779
Name:LANDRY, COLLEEN ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:ANN
Last Name:LANDRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:COLLEEN
Other - Middle Name:ANN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:320 LENNON LN
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2419
Mailing Address - Country:US
Mailing Address - Phone:623-734-3413
Mailing Address - Fax:
Practice Address - Street 1:320 LENNON LN
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2419
Practice Address - Country:US
Practice Address - Phone:925-906-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132912207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z123893Medicare PIN