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Individual

IAN LANDIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
5201 BABCOCK ST NE, SUITE 5, PALM BAY, FL 32905-4637
(321) 676-5323
(321) 951-9253
Mailing address
215 RIVERWAY DR, VERO BEACH, FL 32963-2637
(772) 231-6170
(321) 951-9253

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
OS0004065
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
042068900
FL
01
0782103
CIGNA
FL
01
102370
AVMED
FL
01
120001775
RAILROAD MEDICARE
FL
01
1209448
FIRST HEALTH/MAIL HANDLER
FL
01
1488395
UNITED HEALTHCARE
FL
01
16-00554
UNITEDHEALTHCARE MEDIPASS
FL
05
161752100
FL
01
17030
STAYWELL/HEALTHEASE
FL
01
288660
AMERIGROUP
FL
01
40016
FLORIDIANCARE
FL
01
820868
AETNA
FL
01
FDA 155978
EMBRACED PROGRAM
FL
01
OS0004065
WORKERS COMPENSATION
FL
01
V2489
BCBS OF FLORIDA
FL
Enumeration date
10/12/2006
Last updated
11/28/2007
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