Healthcare Provider Details

I. General information

NPI: 1790730760
Provider Name (Legal Business Name): FRITJOF FLUGE LANGELAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 06/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 10TH AVE STE 178
SALT LAKE CITY UT
84103-2853
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-408-5155
  • Fax: 801-408-5156
Mailing address:
  • Phone: 801-408-5155
  • Fax: 801-408-5156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number160880-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: