Provider Demographics
NPI:1588054415
Name:DR. STEPHEN ELLIS LANDAY
Entity type:Organization
Organization Name:DR. STEPHEN ELLIS LANDAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LANDAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-331-6830
Mailing Address - Street 1:7109 NW 11TH PL STE E
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-3141
Mailing Address - Country:US
Mailing Address - Phone:352-331-6830
Mailing Address - Fax:352-331-2573
Practice Address - Street 1:7109 NW 11TH PL STE E
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3141
Practice Address - Country:US
Practice Address - Phone:352-331-6830
Practice Address - Fax:352-331-2573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME22129261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1255396107OtherNPI