Individual
TRAVIS J LANDRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
602 N ACADIA RD, THIBODAUX, LA 70301-4847
(985) 493-4727
(985) 449-4603
Mailing address
602 N ACADIA RD, THIBODAUX, LA 70301-4847
(985) 493-4727
(985) 449-4603
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
LA10521RX
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023353
—
LA
Enumeration date
08/15/2006
Last updated
09/21/2011
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