Provider Demographics
NPI:1174611875
Name:LANDIS, LLOYD B (DPM)
Entity type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:B
Last Name:LANDIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 12TH AVENUE NW
Mailing Address - Street 2:SUITE F
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401
Mailing Address - Country:US
Mailing Address - Phone:580-223-0718
Mailing Address - Fax:580-223-0719
Practice Address - Street 1:2002 12TH AVENUE NW
Practice Address - Street 2:SUITE F
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401
Practice Address - Country:US
Practice Address - Phone:580-223-0718
Practice Address - Fax:580-223-0719
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK217213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00093162OtherRAILROAD MC
243317401Medicare ID - Type Unspecified
U95753Medicare UPIN
P00093162OtherRAILROAD MC