Healthcare Provider Details

I. General information

NPI: 1316126980
Provider Name (Legal Business Name): TIM S LANGDON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 04/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MP 123 TOK CUTOFF UTHC
TOK AK
99780-0129
US

IV. Provider business mailing address

PO BOX 875
TOK AK
99780-0875
US

V. Phone/Fax

Practice location:
  • Phone: 907-883-5185
  • Fax:
Mailing address:
  • Phone: 907-738-8173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WF0300X
TaxonomyFlight Registered Nurse
License Number21966
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number21966
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: