Provider Demographics
NPI:1821064106
Name:LANDRY, WILLIAM N III (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:N
Last Name:LANDRY
Suffix:III
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 1:121 LAKEVIEW CIR STE C
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7521
Mailing Address - Country:US
Mailing Address - Phone:985-892-1111
Mailing Address - Fax:985-892-1116
Practice Address - Street 1:121 LAKEVIEW CIR STE C
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7521
Practice Address - Country:US
Practice Address - Phone:985-892-1111
Practice Address - Fax:985-892-1116
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017705207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1383066Medicaid
LA54952Medicare PIN
LAD04255Medicare UPIN