Provider Demographics
NPI:1255370086
Name:LANGLEY, MICHAEL GREGORY (PA-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GREGORY
Last Name:LANGLEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6950 E WILLIAMS FIELD RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-6033
Mailing Address - Country:US
Mailing Address - Phone:602-277-5551
Mailing Address - Fax:602-222-6496
Practice Address - Street 1:6950 E WILLIAMS FIELD RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-6033
Practice Address - Country:US
Practice Address - Phone:602-277-5551
Practice Address - Fax:602-222-6496
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2102363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP46794Medicare UPIN