Provider Demographics
NPI:1386658821
Name:LANGLEY, KENNETH E (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:E
Last Name:LANGLEY
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 1:2201 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-5382
Mailing Address - Country:US
Mailing Address - Phone:772-461-5660
Mailing Address - Fax:772-468-2134
Practice Address - Street 1:2201 S 10TH ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-5382
Practice Address - Country:US
Practice Address - Phone:772-461-5660
Practice Address - Fax:772-468-2134
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0057299207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063685100Medicaid
B59034Medicare UPIN
FL063685100Medicaid