Healthcare Provider Details

I. General information

NPI: 1053554162
Provider Name (Legal Business Name): DOUBLE RAINBOW SCIENCES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 04/20/2009
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 7550
JACKSON WY
83002-7550
US

V. Phone/Fax

Practice location:
  • Phone: 307-733-4452
  • Fax:
Mailing address:
  • Phone: 307-733-4452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number7777A
License Number StateWY

VIII. Authorized Official

Name: DR. ROBERT D. LANGER
Title or Position: MANAGING MEMBER
Credential: MD, MPH
Phone: 307-733-4452