Doctor Name: | DR. GREGORY C. LANDRUM |
NPI Number: | 1407090012 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PSY.D. |
License Number: | PY0003587 |
Business Practice Address: | 11080 Se Dixie Hwy Hobe Sound, FL - 334555114 |
Business Phone Number: | 7725469103 |
Business Fax Number: | 7725467667 |
Mailing Address: | 11080 Se Dixie Hwy, HOBE SOUND |
State: | FL |
Postal Code: | 334555114 |
Phone Number: | 7725469103 |
Fax Number: | 7725467667 |
NPI Enumeration Date: | 04/27/2009 |
NPI Last Update Date: | 07/15/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PY0003587 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |