Provider Demographics
NPI:1710444922
Name:LANGLEY, ROLAND LEROY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:LEROY
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 1:103 ROCKYWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2357
Mailing Address - Country:US
Mailing Address - Phone:850-729-0560
Mailing Address - Fax:
Practice Address - Street 1:103 ROCKYWOOD WAY
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2357
Practice Address - Country:US
Practice Address - Phone:850-729-0560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-24
Last Update Date:2019-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA162912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry