Provider Demographics
NPI:1720086952
Name:LANGSTON, THOMAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
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 1:1014 N SPRING ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-2918
Mailing Address - Country:US
Mailing Address - Phone:870-399-0077
Mailing Address - Fax:833-607-6390
Practice Address - Street 1:1014 N SPRING ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2918
Practice Address - Country:US
Practice Address - Phone:870-399-0077
Practice Address - Fax:833-607-6390
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7305207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR113835001Medicaid
AR113835001Medicaid
AR51735Medicare ID - Type Unspecified