Provider Demographics
NPI:1861620676
Name:LANDON, THOMAS EDWARD JR (NP)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:EDWARD
Last Name:LANDON
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:38 PASS RD A
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-3107
Mailing Address - Country:US
Mailing Address - Phone:228-865-4464
Mailing Address - Fax:228-865-1331
Practice Address - Street 1:38 PASS RD A
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-3107
Practice Address - Country:US
Practice Address - Phone:228-865-4464
Practice Address - Fax:228-865-1331
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR860221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily