Basic Information
| Provider Information | |||||||||
| NPI: | 1962430058 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANDER | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 55310 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352555310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057319701 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 619 19TH STREET SOUTH | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059344011 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 07/05/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | L2355DP | AL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 051512835 | 01 | AL | BLUE CROSS | OTHER | 009932667 | 05 | AL | MEDICAID | 051509915 | 01 | AL | BLUE CROSS | OTHER | 051509916 | 01 | AL | BLUE CROSS | OTHER | 051509917 | 01 | AL | BLUE CROSS | OTHER | 009932666 | 05 | AL | MEDICAID | 051551736 | 05 | AL | MEDICAID | 009932664 | 05 | AL | MEDICAID | 009992570 | 05 | AL | MEDICAID | 009936954 | 05 | AL | MEDICAID | 009909505 | 05 | AL | MEDICAID | 009992580 | 05 | AL | MEDICAID |