Healthcare Provider Details

I. General information

NPI: 1407240484
Provider Name (Legal Business Name): JOSEPH LANG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12959 ALDINE WESTFIELD RD # B
HOUSTON TX
77039-5307
US

IV. Provider business mailing address

4650 WESTWAY PARK BLVD STE 206
HOUSTON TX
77041-2006
US

V. Phone/Fax

Practice location:
  • Phone: 713-461-2915
  • Fax: 713-461-5307
Mailing address:
  • Phone: 713-461-2915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1011811
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: