DR. DALE THOMAS LANDRY JR. (NPI# 1518108588) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518108588 |
| Entity Type | Individual |
| Full Name | DR. DALE THOMAS LANDRY JR. |
| Credential | M.D. |
| Practice Address |
1034 Mar Walt Dr Suite 100 Fort Walton Beach FL 32547-6639 |
| Practice Telephone | 8508632153 |
| Practice Fax Number | 8503159350 |
| Mailing Telephone | 8508632153 |
| Mailing Fax Number | 8503159350 |
| Enumeration Date | 2009-03-20 |
| Last Update Date | 2016-06-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207X00000X | Orthopaedic Surgery | ME123092 | FL | Allopathic & Osteopathic Physicians |
| N | 207XS0117X |
Orthopaedic Surgery Specialization: Orthopaedic Surgery of the Spine |
ME 123092 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BCBS FL | 151CH | 01 |
| FL | FL MEDICAID | APPLYING ATN 598515 | 01 |
| MEDICARE PTAN | Z170402 | 01 | |
| FL | MEDICAL LICENSE | ME123092 | 01 |
| DEA | FL4773873 | 01 |
| Street Address |
1034 MAR WALT DR SUITE 100 |
| City | FORT WALTON BEACH |
| State | FL |
| Zip Code | 32547-6639 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235133646 | Jason W Thackeray | Orthopaedic Surgery | 1034 Mar Walt Dr, Suite 100, Fort Walton Beach, FL 32547-6645 | 2005-06-13 |
| 1013535954 | Ruben Jonathan Ruiz | Physical Therapist | 1034 Mar Walt Dr, Fort Walton Beach, FL 32547-6639 | 2020-07-07 |
| 1770969875 | Mark Graeber | Podiatrist | 1034 Mar Walt Dr, Fort Walton Beach, FL 32547-6639 | 2015-07-31 |
| 1639514706 | Benjamin Gavin Merckle | Specialist/Technologist, Other | 1034 Mar Walt Dr, Fort Walton Beach, FL 32547-6639 | 2013-05-02 |
| 1467701862 | James F. Watt Do Pa | Orthopaedic Surgery | 1034 Mar Walt Dr, Suite 100, Fort Walton Beach, FL 32547-6639 | 2012-08-31 |
| 1396072765 | The Spine Institute At Orthopaedic Associates Pl | Orthopaedic Surgery | 1034 Mar Walt Dr, Suite 310, Fort Walton Beach, FL 32547-6645 | 2009-11-05 |
| 1467687350 | Thomas Arthur Fusco | Podiatrist | 1034 Mar Walt Dr, Suite 100, Fort Walton Beach, FL 32547-6639 | 2009-05-20 |
| 1144462110 | Michael L Shawbitz M D P A | Psychiatry & Neurology | 1034 Mar Walt Dr, Suite 100, Fort Walton Beach, FL 32547-6639 | 2009-04-06 |
| 1770745960 | Robert Francis Hofmann | Ophthalmology | 1034 Mar Walt Dr, Ste 200, Fort Walton Beach, FL 32547-6639 | 2008-06-28 |
| 1700087897 | James F Watt | Orthopaedic Surgery | 1034 Mar Walt Dr, Suite 100, Fort Walton Beach, FL 32547-6639 | 2007-05-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255944955 | Theresa Ann Morvay | Behavior Technician | 419 Racetrack Rd Ne, Fort Walton Beach, FL 32547 | 2020-08-24 |
| 1588295422 | Emily Ann Glossop | Nurse Practitioner | 930 Mar Walt Drive C, Fort Walton Beach, FL 32547 | 2020-01-29 |
| 1225669443 | Elizabeth Rogers Nagengast | Physician Assistant | 930 Mar Walt Drive, Unit C, Fort Walton Beach, FL 32547 | 2020-01-27 |
| 1497254791 | Carmen Alston | Nurse Practitioner | 930 Mar Walt Dr C, Fort Walton Beach, FL 32547 | 2018-02-02 |
| 1871004960 | Center for Neuropsychological Services Cns | Clinical Neuropsychologist | 1817 Lewis Turner Blvd, Fort Walton Beach, FL 32547 | 2017-10-17 |
| 1194235648 | Robin Wray | Speech-Language Pathologist | 930 Mar Walt Dr D, Fort Walton Beach, FL 32547 | 2017-10-10 |
| 1285007989 | Dynamic Pain & Wellness Pllc | Pain Medicine | 930 Marwalt Drive, Suite B and C, Fort Walton Beach, FL 32547 | 2015-11-04 |
| 1013392810 | Terry Abbott | Social Worker | 648 Overbrook Dr, Fort Walton Beach, FL 32547 | 2015-07-22 |
| 1083024673 | Emily Lohr | Physical Therapy Assistant | 2000 Principle Ln, Ft. Walton Beach, FL 32547 | 2014-05-05 |
| 1831526102 | Laurie Ann Schweppe | Nurse Practitioner | 1005 Mar Walt Drivve, Snf Hospitalist Department, Fort Walton Beach, FL 32547 | 2013-10-02 |
| Find all providers in zip 32547 | ||||
| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053406512 | Anthony Joseph Brothers | Orthopaedic Surgery | 341 Racetrack Rd Nw Ste B, Suite 114, Fort Walton Beach, FL 32547-1552 | 2006-10-03 |
| 1235133646 | Jason W Thackeray | Orthopaedic Surgery | 1034 Mar Walt Dr, Suite 100, Fort Walton Beach, FL 32547-6645 | 2005-06-13 |
| 1952305484 | Theodore I Macey | Orthopaedic Surgery | 1034 Mar Walt Dr Ste 100, Fort Walton Beach, FL 32547-6645 | 2005-06-13 |
| 1750797148 | Benjamin Todd Raines | Orthopaedic Surgery | 341 Racetrack Rd Nw, Fort Walton Beach, FL 32547-1787 | 2014-07-07 |
| 1063857753 | Brandon Wade Cook | Orthopaedic Surgery | 1034 Mar Walt Dr Unit 100, Fort Walton Beach, FL 32547 | 2013-05-08 |
| 1467701862 | James F. Watt Do Pa | Orthopaedic Surgery | 1034 Mar Walt Dr, Suite 100, Fort Walton Beach, FL 32547-6639 | 2012-08-31 |
| 1396072765 | The Spine Institute At Orthopaedic Associates Pl | Orthopaedic Surgery | 1034 Mar Walt Dr, Suite 310, Fort Walton Beach, FL 32547-6645 | 2009-11-05 |
| 1861658338 | John C Warburton Md Pa | Orthopaedic Surgery | 1034 Mar Walt Dr Ste 100, Fort Walton Beach, FL 32547-6645 | 2008-08-04 |
| 1700087897 | James F Watt | Orthopaedic Surgery | 1034 Mar Walt Dr, Suite 100, Fort Walton Beach, FL 32547-6639 | 2007-05-29 |
| 1003902354 | Matthew Christopher Mai | Orthopaedic Surgery | 928d Mar Walt Dr, Fort Walton Beach, FL 32547-6706 | 2006-10-05 |
| Find all providers in FORT WALTON BEACH | ||||
| City | FORT WALTON BEACH |
| Zip Code | 32547 |
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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.