Provider Demographics
NPI:1386022507
Name:LANGE, JUSTIN M (DO)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:M
Last Name:LANGE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 E FRONT AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2139
Mailing Address - Country:US
Mailing Address - Phone:509-626-9900
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:624 E FRONT AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2139
Practice Address - Country:US
Practice Address - Phone:509-626-9900
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP61076565207Q00000X
AK100988207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine