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NPI Code Detail

MEDICARE: DR. MAYNARD F. LANG M.D.

MEDICARE: DR. MAYNARD F. LANG M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice PhysicianC29340CA

General Provider Information

NPI Number : 1396720355
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MAYNARD F. LANG M.D.
Provider Business Mailing Address
First Line : 3400 DATA DRIVE
Second Line : PHYSICIAN SUPPORT SERVICES, 2ND FLOOR
City : RANCHO CORDOVA
State : CA
Zip : 95670-7956
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 782 EAST HARDING WAY
Second Line :
City : STOCKTON
State : CA
Zip : 95205-6101
Country : US
Telephone Number : 209-475-5500
Fax Number : 209-466-1982
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2005
Last Update Date : 07/02/2014

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Directions to “ DR. MAYNARD F. LANG M.D.” Practice Location

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