Provider Demographics
NPI:1962430058
Name:LANDER, PHILIP H (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:H
Last Name:LANDER
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 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:619 19TH STREET SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233
Practice Address - Country:US
Practice Address - Phone:205-934-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL2355DP2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051512835OtherBLUE CROSS
AL009932667Medicaid
AL051509915OtherBLUE CROSS
AL051509916OtherBLUE CROSS
AL051509917OtherBLUE CROSS
AL009932666Medicaid
AL051551736Medicaid
AL009932664Medicaid
AL009992570Medicaid
AL009936954Medicaid
AL009909505Medicaid
AL009992580Medicaid
AL009992570Medicaid
AL051551736Medicaid