Individual
KEITH J LANDRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
114 HIGHWAY 403, PAINCOURTVILLE, LA 70390
(985) 369-3514
(985) 252-1400
Mailing address
PO BOX 5478, THIBODAUX, LA 70302-5478
(985) 447-5500
(985) 449-2535
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
017704
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1348643
—
LA
01
—
300093737
RAILROAD MEDICARE
LA
Enumeration date
08/16/2006
Last updated
07/05/2018
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