Provider Demographics
NPI:1356372973
Name:LANDRES, RICHARD T (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:T
Last Name:LANDRES
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 1020
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95201-3120
Mailing Address - Country:US
Mailing Address - Phone:209-468-6000
Mailing Address - Fax:209-468-7042
Practice Address - Street 1:500 W HOSPITAL RD.
Practice Address - Street 2:
Practice Address - City:FRENCH CAMP
Practice Address - State:CA
Practice Address - Zip Code:95231-9989
Practice Address - Country:US
Practice Address - Phone:209-468-6000
Practice Address - Fax:209-468-6937
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG21484207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41296Medicare UPIN
CA00G214840Medicare ID - Type Unspecified