Provider Demographics
NPI:1689727851
Name:LANDER, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:LANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3009 N BALLAS RD
Mailing Address - Street 2:SUITE 105B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2322
Mailing Address - Country:US
Mailing Address - Phone:314-432-2323
Mailing Address - Fax:314-432-5328
Practice Address - Street 1:3009 N BALLAS RD
Practice Address - Street 2:SUITE 105B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2322
Practice Address - Country:US
Practice Address - Phone:314-432-2323
Practice Address - Fax:314-432-5328
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR5920207X00000X
IL036-107507207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00182423OtherRR MEDICARE
MO113209OtherBCBS OF MO (ANTHEM)
MO200540151Medicaid
ILP00158785OtherRR MEDICARE
11991OtherGROUP HEALTH PLAN
126430OtherHEALTHLINK, INC.
2192050002OtherCIGNA
IL079274OtherHEALTH ALLIANCE
4071501OtherAETNA
A13562OtherMERCY HEALTH PLANS
IL7932006OtherBCBS OF IL
43092556563080A001OtherWPS TRICARE
0900160OtherUHC
IL203342Medicare ID - Type Unspecified
A13562OtherMERCY HEALTH PLANS
126430OtherHEALTHLINK, INC.
007010541Medicare PIN