Provider Demographics
NPI:1790082204
Name:LANDERS INTERNAL MEDICINE, LLC
Entity Type:Organization
Organization Name:LANDERS INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:D
Authorized Official - Last Name:LANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-778-6122
Mailing Address - Street 1:PO BOX 283
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-0283
Mailing Address - Country:US
Mailing Address - Phone:985-778-6122
Mailing Address - Fax:
Practice Address - Street 1:507 EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-7574
Practice Address - Country:US
Practice Address - Phone:985-778-6122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023138207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty