Individual
MR. MARK J LANDRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
3621 AMBASSADOR CAFFERY PKWY STE 100, LAFAYETTE, LA 70503-5132
(337) 534-4410
Mailing address
2851 JOHNSTON ST, LAFAYETTE, LA 70503-3243
(337) 456-3519
(337) 534-4426
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
RN095042
LA
363LF0000X
Family Nurse Practitioner
Primary
AP04519
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467430
—
LA
Enumeration date
06/19/2006
Last updated
02/17/2023
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