Provider Demographics
NPI:1134360803
Name:LANDES, WILLIAM A (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:LANDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:36406 IRONHORSE DR
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-7973
Mailing Address - Country:US
Mailing Address - Phone:540-348-4193
Mailing Address - Fax:540-348-4193
Practice Address - Street 1:36406 IRONHORSE DR
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-7973
Practice Address - Country:US
Practice Address - Phone:540-348-4193
Practice Address - Fax:540-348-4193
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG68279207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G682790OtherSTATE LICENSE
CABL5243679OtherDEA