Individual
PAUL B LANDRY III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
310 N STATE OF FRANKLIN RD, SUITE 101, JOHNSON CITY, TN 37604-6008
(423) 929-7393
(423) 929-0872
Mailing address
310 N STATE OF FRANKLIN RD, SUITE 101, JOHNSON CITY, TN 37604-6008
(423) 929-7393
(423) 929-0872
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1603
TN
363AS0400X
Surgical Physician Assistant
1603
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1477599892
—
VA
05
—
1506078
—
TN
01
—
4190518
BC/BS
TN
05
—
7100095460
—
KY
01
—
P00686005
RAILROAD MEDICARE
TN
01
—
TN01 UW
JOHN DEERE
TN
Enumeration date
06/22/2006
Last updated
02/15/2017
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