Provider Demographics
NPI:1821376385
Name:LANDERS, THOMAS JR (MA 60234020)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:LANDERS
Suffix:JR
Gender:M
Credentials:MA 60234020
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5361 S TRAFTON ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7011
Mailing Address - Country:US
Mailing Address - Phone:253-229-1507
Mailing Address - Fax:
Practice Address - Street 1:5361 S TRAFTON ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7011
Practice Address - Country:US
Practice Address - Phone:253-229-1507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60234020174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist