DEREK TODD LANDIS (NPI# 1487854642) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487854642 |
| Entity Type | Individual |
| Full Name | DEREK TODD LANDIS |
| Credential | MD |
| Practice Address |
921 14th Ave Nw Ardmore OK 73401-1837 |
| Mailing Address |
4401 W Memorial Rd Suite 140 Oklahoma City OK 73134-1785 |
| Practice Telephone | 5802235311 |
| Practice Fax Number | 5802238227 |
| Mailing Telephone | 4057523162 |
| Mailing Fax Number | 4059365211 |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2014-05-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 25666 | OK | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | OBNDD LICENSE | 36032 | 01 |
| OK | OKLAHOMA MEDICAL LICENSE | 25666 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285022178 | Derek Landis | Physical Therapist | 7 Carnegie Plz, Cherry Hill, NJ 08003-1000 | 2014-12-31 |
| Street Address |
921 14TH AVE NW |
| City | ARDMORE |
| State | OK |
| Zip Code | 73401-1837 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457331175 | Medical Arts Clinic of Ardmore Inc | Internal Medicine | 921 14th Ave Nw, Ardmore, OK 73401-1837 | 2006-01-19 |
| 1912395898 | Lisa Burton | Nurse Practitioner | 921 14th Ave Nw, Ardmore, OK 73401-1837 | 2014-12-31 |
| 1932448347 | Jerad Scott Wagner | Physician Assistant | 921 14th Ave Nw, Ardmore, OK 73401-1837 | 2013-02-05 |
| 1376703595 | Summer Kirby | Family Medicine | 921 14th Ave Nw, Ardmore, OK 73401-1837 | 2008-06-11 |
| 1205929320 | Ashley V Kelley | Internal Medicine | 921 14th Ave Nw, Ardmore, OK 73401-1837 | 2006-10-02 |
| 1679595144 | Bobby J Ellis | Internal Medicine | 921 14th Ave Nw, Ardmore, OK 73401-1837 | 2006-07-24 |
| 1306889878 | Sallie J Walker | Nurse Practitioner | 921 14th Ave Nw, Ardmore, OK 73401-1837 | 2006-06-13 |
| 1235176629 | Wilfred S Gauthier | Surgery | 921 14th Ave Nw, Ardmore, OK 73401-1837 | 2006-06-02 |
| 1194779975 | Toribio C Velasquez | Internal Medicine | 921 14th Ave Nw, Ardmore, OK 73401-1837 | 2006-05-19 |
| 1114982527 | Mercy Health Services - Southern Oklahoma, LLC | Clinic/Center | 921 14th Ave Nw, Ardmore, OK 73401-1837 | 2006-04-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497391452 | Abbie Deeann Mclemore | Nurse Practitioner | 915 10th Ave, Ardmore, OK 73401 | 2019-11-25 |
| 1790349991 | Shirley Denise Brown | Licensed Psychiatric Technician | 1219 Kst N.w, 1219 Kst N.w, Ardmore, OK 73401 | 2019-04-24 |
| 1427512359 | Billy Joe Oshields | Case Manager/Care Coordinator | 6862 State Hwy 199 Ardmore Oklahoma, 6862 State Hwy 199, Ardmore, OK 73401 | 2019-01-24 |
| 1174007595 | Tawnya Dawn Peery | Nurse Practitioner | 1108 W. Walnut Drive, Ardmore, OK 73401 | 2018-09-21 |
| 1679055016 | Teresa Marie Hernandez | Behavior Technician | 1219 K St. Nw, Ardmore, OK 73401 | 2018-09-01 |
| 1063991974 | Sawyer Rae Shamburger | Occupational Therapy Assistant | 208 North Praire St, Pilot Point, TX 73401 | 2018-08-10 |
| 1417473521 | Chelsye Bacon | Peer Specialist | 905 Holiday Drive, Ardmore, OK 73401 | 2017-08-21 |
| 1003279746 | Jeni Presley | Marriage & Family Therapist | Outpatient Services-ardmore; 2510 Chickasaw Dr., Strong Family Development;, Ardmore, OK 73401 | 2016-03-31 |
| 1982080909 | Alison Hill | Pharmacist | 1111 N. Commerce, Ardmore, OK 73401 | 2015-07-31 |
| 1316346547 | Olivia Larae Carrell | Counselor | 15 Monroe Street Ne, Ardmore, OK 73401 | 2014-08-13 |
| Find all providers in zip 73401 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699041681 | Richard M Gesser | Pediatrics | 132 Elm Ave, Ardmore, PA 19003-2144 | 2012-03-24 |
| 1396986840 | Emily Siege | Pediatrics | 623 Valley View Rd, Ardmore, PA 19003-1028 | 2009-03-12 |
| 1720051774 | Teuta Henci | Pediatrics | 233 E Lancaster Ave, Suite 300, Ardmore, PA 19003-2321 | 2006-02-09 |
| 1013914324 | Gwen Canarias Fuentes | Pediatrics | 919 15th Ave Nw, Ardmore, OK 73401-1809 | 2005-06-30 |
| 1083830608 | Gwen Fuentes Md Pediatric Clinic | Pediatrics | 919 15th Ave Nw, Ardmore, OK 73401-1809 | 2007-04-18 |
| 1467593210 | Lisa Christine Hoffman | Pediatrics | 1020 N Commerce St, Ardmore, OK 73401-3920 | 2007-02-12 |
| 1649327727 | Frank H. King Jr. | Pediatrics | 100 Church Rd, Suite 300, Ardmore, PA 19003-2316 | 2007-01-04 |
| 1265599740 | Alexandra S Bartlett | Pediatrics | 100 Church Rd, Suite 300, Ardmore, PA 19003-2316 | 2007-01-03 |
| 1881751451 | William S Zavod | Pediatrics | 100 Church Rd, Suite 300, Ardmore, PA 19003-2316 | 2007-01-03 |
| 1235206921 | Zavod King Bartlett Pediatrics | Pediatrics | 100 Church Rd, Suite 300, Ardmore, PA 19003 | 2006-11-29 |
| Find all providers in ARDMORE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.