Provider Demographics
NPI:1093965451
Name:CHARLES G. LANGHAM III, M.D., P.A.
Entity Type:Organization
Organization Name:CHARLES G. LANGHAM III, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:G
Authorized Official - Last Name:LANGHAM
Authorized Official - Suffix:III
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:817-921-6091
Mailing Address - Street 1:1307 8TH AVE
Mailing Address - Street 2:201
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4137
Mailing Address - Country:US
Mailing Address - Phone:817-921-6091
Mailing Address - Fax:817-921-9163
Practice Address - Street 1:1307 8TH AVE
Practice Address - Street 2:201
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4137
Practice Address - Country:US
Practice Address - Phone:817-921-6091
Practice Address - Fax:817-921-9163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4467207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1912092743OtherNPI
TX123419702Medicaid
TX1912092743OtherNPI
TX123419702Medicaid