Individual
JARED LANDRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
602 N ACADIA RD, ANESTHESIA DEPT., THIBODAUX, LA 70301-4847
(985) 438-1188
Mailing address
119 W LAKESHORE DR, THIBODAUX, LA 70301-1607
(337) 802-2639
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD.206604
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2106961
—
LA
01
—
300093737
RAILROAD MEDICARE PTAN
LA
Enumeration date
03/19/2010
Last updated
12/02/2024
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