Individual
ERIC LANDRY PROVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8857 1ST ST STE 400, NORFOLK, VA 23511-3713
(757) 445-7256
(757) 576-4161
Mailing address
8857 1ST ST STE 400, NORFOLK, VA 23511-3713
(757) 445-7256
(757) 576-4161
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1710I1002X
INDEPENDENT DUTY CORPSMAN
VA
Enumeration date
03/21/2006
Last updated
10/14/2009
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