Landry, Larry Jackson

Landry, Larry Jackson is an individual health care provider with primary practice located at 2200 W Eau Gallie Blvd Suite 202A, Melbourne FL 32935-3166. He recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as his primary health care specialty. Landry, Larry Jackson can be contacted via phone (321) 253-1992.

Contact Information

Primary practice address
2200 W Eau Gallie Blvd Suite 202A Melbourne FL 32935-3166
Phone: (321) 253-1992
Fax: (321) 253-1844
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Urology 208800000X ME95172 Florida

Profile Details

NPI number 1134194608
LBN Legal business name Landry, Larry Jackson
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 20th, 2006
Last updated Apr 8th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1134194608 NPPES
Florida Other 325257 WELLCARE
Florida Other 557262 WELLCARE
Florida Other P00334279 WELLCARE
Florida MEDICAID 274787100 WELLCARE
Florida Other 2836813001 WELLCARE
Florida Other 37428 WELLCARE
Florida Other 1226087 WELLCARE

Popular Providers