Provider Demographics
NPI:1780858217
Name:LANDES, JEFFERY S (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:S
Last Name:LANDES
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 1:9393 E PALO BREA BND APT 2074
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-6515
Mailing Address - Country:US
Mailing Address - Phone:480-272-8826
Mailing Address - Fax:
Practice Address - Street 1:9393 E PALO BREA BND APT 2074
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-6515
Practice Address - Country:US
Practice Address - Phone:480-272-8826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03779900174400000X
AZ44120174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist