Provider Demographics
NPI:1013930643
Name:LANDIS, DANIEL M (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:M
Last Name:LANDIS
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:PO BOX 749730
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-9730
Mailing Address - Country:US
Mailing Address - Phone:206-971-0034
Mailing Address - Fax:206-215-4351
Practice Address - Street 1:1560 N 115TH ST
Practice Address - Street 2:C/O SWEDISH CANCER INSTITUTE @ NORTHWEST
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133
Practice Address - Country:US
Practice Address - Phone:206-386-6707
Practice Address - Fax:206-363-5907
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000459702085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8448193Medicaid
I50917Medicare UPIN
8859385Medicare ID - Type Unspecified