Provider Demographics
NPI:1659374957
Name:LAND, GARRY A (MD)
Entity Type:Individual
Prefix:DR
First Name:GARRY
Middle Name:A
Last Name:LAND
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 1:2315 16TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-3305
Mailing Address - Country:US
Mailing Address - Phone:563-242-3937
Mailing Address - Fax:
Practice Address - Street 1:2315 16TH ST NW
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-3305
Practice Address - Country:US
Practice Address - Phone:563-242-3937
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22022207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA22022OtherIOWA LICENSE
IA2173906Medicaid
IAAL9320792OtherDEA NUMBER
IA22022OtherIOWA LICENSE
IA2173906Medicaid