Healthcare Provider Details

I. General information

NPI: 1992822464
Provider Name (Legal Business Name): TYRONE LANGAGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 ASH AVE E
GLEN ULLIN ND
58631
US

IV. Provider business mailing address

1112 9TH ST SW
MINOT ND
58701-9109
US

V. Phone/Fax

Practice location:
  • Phone: 701-348-9175
  • Fax:
Mailing address:
  • Phone: 701-838-0937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3506
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: