Individual
LARRY JACKSON LANDRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2200 W EAU GALLIE BLVD, SUITE 202A, MELBOURNE, FL 32935-3166
(321) 253-1992
(321) 253-1844
Mailing address
240 N WICKHAM RD, STE 104, MELBOURNE, FL 32935-8663
(321) 253-1992
(321) 253-1844
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
ME95172
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1226087
AETNA
FL
05
—
274787100
—
FL
01
—
2836813001
CIGNA
FL
01
—
325257
WELLCARE
FL
01
—
37428
BLUE CROSS BLUE SHIELD
FL
01
—
557262
AETNA
FL
01
—
P00334279
RAILROAD MEDICARE
FL
Enumeration date
02/20/2006
Last updated
04/08/2016
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