Provider Demographics
NPI:1255343174
Name:LANGEVIN, JAMES MAURICE (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MAURICE
Last Name:LANGEVIN
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 1:124 E AYCOCK CT
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76088-5018
Mailing Address - Country:US
Mailing Address - Phone:806-382-0684
Mailing Address - Fax:
Practice Address - Street 1:118 E HASKELL ST STE D
Practice Address - Street 2:
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445
Practice Address - Country:US
Practice Address - Phone:775-621-5699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2018-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8784208600000X
NV16619208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030900701Medicaid
TX00685JMedicare ID - Type Unspecified
TX030900701Medicaid