Provider Demographics
NPI:1639120538
Name:LAWRENCE, LANDAU P (MD)
Entity Type:Individual
Prefix:
First Name:LANDAU
Middle Name:P
Last Name:LAWRENCE
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:PO BOX 1990
Mailing Address - Street 2:
Mailing Address - City:TUBAC
Mailing Address - State:AZ
Mailing Address - Zip Code:85646-1990
Mailing Address - Country:US
Mailing Address - Phone:520-398-9054
Mailing Address - Fax:520-398-2944
Practice Address - Street 1:26 TUBAC ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:TUBAC
Practice Address - State:AZ
Practice Address - Zip Code:85646-1990
Practice Address - Country:US
Practice Address - Phone:520-398-9054
Practice Address - Fax:520-398-2944
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27940207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZC18205Medicare UPIN
AZZ109950Medicare PIN