Provider Demographics
NPI:1811130982
Name:LANGSETH, JERRY E (DO)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:E
Last Name:LANGSETH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2010
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34682-2010
Mailing Address - Country:US
Mailing Address - Phone:727-804-7404
Mailing Address - Fax:
Practice Address - Street 1:4700 9TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-6123
Practice Address - Country:US
Practice Address - Phone:727-327-4377
Practice Address - Fax:727-321-8072
Is Sole Proprietor?:No
Enumeration Date:2009-04-19
Last Update Date:2009-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 3213207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine