Individual
DAVID M LANDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
703 S AMERICANA BLVD, STE 130, BOISE, ID 83702-5099
(208) 706-7500
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
(208) 426-4634
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA165
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RPA-165
LICENSE NO
ID
Enumeration date
04/23/2007
Last updated
01/15/2014
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