Provider Demographics
NPI:1194059477
Name:LANDRY, ANAYDA GRACIELA (MD)
Entity type:Individual
Prefix:DR
First Name:ANAYDA
Middle Name:GRACIELA
Last Name:LANDRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 S STAPLES ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-5543
Mailing Address - Country:US
Mailing Address - Phone:361-994-7255
Mailing Address - Fax:361-994-7740
Practice Address - Street 1:7101 S STAPLES ST STE 101
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-5543
Practice Address - Country:US
Practice Address - Phone:361-994-7255
Practice Address - Fax:361-994-7740
Is Sole Proprietor?:No
Enumeration Date:2009-09-20
Last Update Date:2009-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3811207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121271401Medicaid
TXN3811OtherMEDICAL LICENSE