Healthcare Provider Details

I. General information

NPI: 1023078128
Provider Name (Legal Business Name): ROBERT D. LANGER M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E. BROADWAY SUITE 108
JACKSON WY
83001
US

IV. Provider business mailing address

PO BOX 7559
JACKSON WY
83002-7559
US

V. Phone/Fax

Practice location:
  • Phone: 307-733-4452
  • Fax: 877-596-6503
Mailing address:
  • Phone: 619-993-4360
  • Fax: 877-596-6503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberG39841
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberMD427306
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number7777A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: