Provider Demographics
NPI:1982645719
Name:LANDIS, GEOFFREY S (DO)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:S
Last Name:LANDIS
Suffix:
Gender:M
Credentials:DO
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 31630
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1630
Mailing Address - Country:US
Mailing Address - Phone:520-382-8200
Mailing Address - Fax:520-382-8136
Practice Address - Street 1:6320 N LA CHOLLA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3548
Practice Address - Country:US
Practice Address - Phone:520-382-8200
Practice Address - Fax:520-382-8136
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4402207XX0004X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ083983Medicaid
I28215Medicare UPIN
AZ083983Medicaid