Individual
MR. CLINT L VANLANDINGHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
2600 KANELL BLVD, POPLAR BLUFF, MO 63901-3001
(573) 785-4546
(573) 785-6959
Mailing address
2600 KANELL BLVD, POPLAR BLUFF, MO 63901-3001
(573) 785-4546
(573) 785-6959
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
2004001321
MO
213ES0103X
Foot & Ankle Surgery Podiatrist
2004001321
MO
363LF0000X
Family Nurse Practitioner
2014037662
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
309166510
—
MO
Enumeration date
02/03/2006
Last updated
01/27/2020
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