Provider Demographics
NPI:1013903640
Name:LANGSTON, WILLIAM G (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:G
Last Name:LANGSTON
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 1:1885 MAIN ST
Mailing Address - Street 2:#407
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1819
Mailing Address - Country:US
Mailing Address - Phone:808-244-5513
Mailing Address - Fax:
Practice Address - Street 1:221 MAHALANI ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2526
Practice Address - Country:US
Practice Address - Phone:808-242-2290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00026726207P00000X
HIMD-13539207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL7820686OtherAETNA
AL051530205OtherBCBS PROVIDER NUMBER
HI626749Medicaid
HI0000281071OtherBLUECROSSBLUESHIELD
AL009935826Medicaid
AL051556498Medicaid
HIBA508ZMedicare PIN
AL7820686OtherAETNA
HI626749Medicaid
AL009935826Medicaid