Provider Demographics
NPI:1710217906
Name:LANGE, W, ALEX (PA)
Entity Type:Individual
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First Name:W, ALEX
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Last Name:LANGE
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Gender:M
Credentials:PA
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Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-644-5185
Mailing Address - Fax:405-644-5184
Practice Address - Street 1:4221 S WESTERN AVE
Practice Address - Street 2:SUITE 5045
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3447
Practice Address - Country:US
Practice Address - Phone:405-644-5185
Practice Address - Fax:405-644-5184
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2016-02-05
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Provider Licenses
StateLicense IDTaxonomies
OK1899363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant