Provider Demographics
NPI:1417042490
Name:ERIC L. LANG DO LC
Entity Type:Organization
Organization Name:ERIC L. LANG DO LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:L
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:321-255-2915
Mailing Address - Street 1:1301 W EAU GALLIE BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-5390
Mailing Address - Country:US
Mailing Address - Phone:321-255-5915
Mailing Address - Fax:321-255-6784
Practice Address - Street 1:1301 W EAU GALLIE BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-5390
Practice Address - Country:US
Practice Address - Phone:321-255-5915
Practice Address - Fax:321-255-6784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC30792Medicare UPIN
FLC30792Medicare UPIN