Individual
JERONE THEODORE LANDSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
633 GOV CARLOS CAMACHO ROAD, SUITE 104 GUAM MEDICAL PLAZA, TAMUNING, GU 96913
(671) 646-4263
(671) 649-1019
Mailing address
633 GOV CARLOS G CAMACHO RD STE 212, TAMUNING, GU 96913-3195
(671) 646-4263
(671) 649-2266
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
M-958
GU
2086S0105X
Surgery of the Hand (Surgery) Physician
J9150
TX
2086S0105X
Surgery of the Hand (Surgery) Physician
Primary
M00958
GU
2086S0105X
Surgery of the Hand (Surgery) Physician
MD9588
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005867019
AETNA
—
01
—
170804300
USDOL
—
05
—
J6266501
—
TX
Enumeration date
11/27/2006
Last updated
04/27/2020
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