Provider Demographics
NPI:1053471102
Name:LANG, JUERGEN (MD)
Entity Type:Individual
Prefix:
First Name:JUERGEN
Middle Name:
Last Name:LANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91500 OVERSEAS HWY
Mailing Address - Street 2:BAPTIST HEALTH MARINERS HOSPITAL
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070
Mailing Address - Country:US
Mailing Address - Phone:305-434-3000
Mailing Address - Fax:
Practice Address - Street 1:91500 OVERSEAS HWY
Practice Address - Street 2:BAPTIST HEALTH MARINERS HOSPITAL
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070
Practice Address - Country:US
Practice Address - Phone:305-434-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME164763207PE0004X
WAMD00030715207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA001083120Medicaid
ID003793700OtherIDAHO MEDICAID