Provider Demographics
NPI:1750330312
Name:LANDES, VALDON GALE (DO)
Entity type:Individual
Prefix:
First Name:VALDON
Middle Name:GALE
Last Name:LANDES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1175 58TH AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-4807
Mailing Address - Country:US
Mailing Address - Phone:970-495-0300
Mailing Address - Fax:970-224-9624
Practice Address - Street 1:1175 58TH AVE
Practice Address - Street 2:STE 202
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4807
Practice Address - Country:US
Practice Address - Phone:970-495-0300
Practice Address - Fax:970-224-9624
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO41081207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO61930784Medicaid
P00255569OtherRAILROAD MEDICARE
WY11826090Medicaid
COFR674273OtherBCBS
CO61930784Medicaid