Provider Demographics
NPI:1609195213
Name:RICHARD R LANDRIGAN M D L L C
Entity Type:Organization
Organization Name:RICHARD R LANDRIGAN M D L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:LANDRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:M D L L C
Authorized Official - Phone:813-684-0808
Mailing Address - Street 1:321 E ROBERTSON ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5253
Mailing Address - Country:US
Mailing Address - Phone:813-685-2191
Mailing Address - Fax:813-689-8755
Practice Address - Street 1:505 EICHENFELD DR
Practice Address - Street 2:SUITE 109
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5985
Practice Address - Country:US
Practice Address - Phone:813-684-0808
Practice Address - Fax:813-689-0825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-21
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0035858208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277890400Medicaid