Healthcare Provider Details

I. General information

NPI: 1467713198
Provider Name (Legal Business Name): JEFFREY LANG M D P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 05/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 CLEVELAND AVE SUITE 806
FORT MYERS FL
33901-5858
US

IV. Provider business mailing address

2780 CLEVELAND AVE SUITE 806
FORT MYERS FL
33901-5858
US

V. Phone/Fax

Practice location:
  • Phone: 239-337-0100
  • Fax: 239-337-0102
Mailing address:
  • Phone: 239-337-0100
  • Fax: 239-337-0102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME19470
License Number StateFL

VIII. Authorized Official

Name: DR. JEFFREY LANG
Title or Position: OWNER
Credential:
Phone: 239-337-0100