Healthcare Provider Details

I. General information

NPI: 1235386335
Provider Name (Legal Business Name): WILLIAM G LANGSTON MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 02/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 MAHALANI ST
WAILUKU HI
96793-2526
US

IV. Provider business mailing address

PO BOX 8488
PHILADELPHIA PA
19101-8488
US

V. Phone/Fax

Practice location:
  • Phone: 808-242-2290
  • Fax:
Mailing address:
  • Phone: 805-563-3011
  • Fax: 805-564-5087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM G LANSTON
Title or Position: PRESIDENT
Credential: MD
Phone: 805-563-3011