Healthcare Provider Details

I. General information

NPI: 1275573875
Provider Name (Legal Business Name): ROBERT LANGENFELD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 S CLARK ST ST. ANTHONY MENTAL HEALTH SERVICES
CARROLL IA
51401-3038
US

IV. Provider business mailing address

267 HILLCREST DR
CARROLL IA
51401-3231
US

V. Phone/Fax

Practice location:
  • Phone: 712-794-5418
  • Fax:
Mailing address:
  • Phone: 712-790-3082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number22737
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: