Provider Demographics
NPI:1215991906
Name:LANDER, STUART R (MD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:R
Last Name:LANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16980 DALLAS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1974
Mailing Address - Country:US
Mailing Address - Phone:972-391-1915
Mailing Address - Fax:972-391-2061
Practice Address - Street 1:902 W RANDOL MILL RD STE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2581
Practice Address - Country:US
Practice Address - Phone:817-461-3003
Practice Address - Fax:844-290-4365
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2733207RC0000X, 207UN0901X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139198919Medicaid
TX139198917Medicaid
TX8DG185OtherBCBS
TX139198918Medicaid
TX8B5152Medicare PIN
TX8A0734Medicare PIN
TXG57941Medicare UPIN
TX139198919Medicaid