Provider Demographics
NPI:1851357529
Name:LANDRUM, ALICE L (MD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:L
Last Name:LANDRUM
Suffix:
Gender:F
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:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:ONE HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-2568
Practice Address - Fax:573-882-2226
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMDR6H66207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA527465OtherIOWA MEDICAID
MO127254OtherBLUE SHIELD/BLUE CHOICE
MO2004020OtherUNITED HEALTHCARE
MO102534OtherHEALTHLINK
MO202509006Medicaid
IA527465OtherIOWA MEDICAID
MO102534OtherHEALTHLINK
A13028Medicare UPIN
MOP00425467Medicare PIN
MO050013921Medicare PIN