Provider Demographics
NPI:1194010389
Name:LANG, SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:LANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3951 NW 48TH TER
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-7228
Mailing Address - Country:US
Mailing Address - Phone:352-265-5230
Mailing Address - Fax:352-265-5231
Practice Address - Street 1:3951 NW 48TH TER
Practice Address - Street 2:SUITE 101
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7228
Practice Address - Country:US
Practice Address - Phone:352-265-5230
Practice Address - Fax:352-265-5231
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2014-12-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLTRN16060207Q00000X
FLME119870207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012357800Medicaid
FLHY219ZMedicare PIN