Provider Demographics
NPI:1780616276
Name:JAMES E LANG MD PA
Entity type:Organization
Organization Name:JAMES E LANG MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-491-1111
Mailing Address - Street 1:4800 NE 20TH TER
Mailing Address - Street 2:SUITE 305
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4510
Mailing Address - Country:US
Mailing Address - Phone:954-491-1111
Mailing Address - Fax:954-491-7017
Practice Address - Street 1:4800 NE 20TH TER
Practice Address - Street 2:SUITE 305
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4510
Practice Address - Country:US
Practice Address - Phone:954-491-1111
Practice Address - Fax:954-491-7017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLME0065330174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34713OtherGROUP BCBS
FL34713OtherGROUP BCBS
FLK3988Medicare ID - Type Unspecified