Provider Demographics
NPI:1821211749
Name:LANGFORD, ROGER PAUL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:PAUL
Last Name:LANGFORD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 HALL AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-6243
Mailing Address - Country:US
Mailing Address - Phone:831-637-8405
Mailing Address - Fax:
Practice Address - Street 1:930 SUNSET DR STE 3
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5620
Practice Address - Country:US
Practice Address - Phone:831-636-2664
Practice Address - Fax:831-636-2641
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA10814363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant