Provider Demographics
NPI:1639164403
Name:LANGSJOEN, PETER HARALD (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:HARALD
Last Name:LANGSJOEN
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 1:1107 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2124
Mailing Address - Country:US
Mailing Address - Phone:903-595-3778
Mailing Address - Fax:903-595-4962
Practice Address - Street 1:1107 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2124
Practice Address - Country:US
Practice Address - Phone:903-595-3778
Practice Address - Fax:903-595-4962
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6857207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
060066132OtherRR MEDICARE
TX110369901Medicaid
060010531OtherTRICARE
060066132OtherRR MEDICARE
00F44QMedicare ID - Type Unspecified