Individual
DR. DALE THOMAS LANDRY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1034 MAR WALT DR, SUITE 100, FORT WALTON BEACH, FL 32547-6639
(850) 863-2153
(850) 315-9350
Mailing address
1034 MAR WALT DR, SUITE 100, FORT WALTON BEACH, FL 32547-6639
(850) 863-2153
(850) 315-9350
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
ME123092
FL
207XS0117X
Orthopaedic Surgery of the Spine Physician
ME 123092
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
151CH
BCBS FL
FL
01
—
APPLYING ATN 598515
FL MEDICAID
FL
01
—
ME123092
MEDICAL LICENSE
FL
01
—
Z170402
MEDICARE PTAN
—
Enumeration date
03/20/2009
Last updated
03/07/2023
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