Provider Demographics
NPI:1891788022
Name:LANDAU, JEFFREY H (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:H
Last Name:LANDAU
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 1:5100 W ELDORADO PKWY
Mailing Address - Street 2:SUITE 102 PMB 901
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6309
Mailing Address - Country:US
Mailing Address - Phone:972-747-4200
Mailing Address - Fax:972-747-4222
Practice Address - Street 1:1105 CENTRAL EXPY N
Practice Address - Street 2:SUITE 350
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6103
Practice Address - Country:US
Practice Address - Phone:972-747-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50587208800000X
TXK4934208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029520602Medicaid
TX8AJ901OtherBLUECROSS BLUE SHIELD
TX00966UMedicare PIN
A92986Medicare UPIN