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General NPI Number Information
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NPI Number | 1093965451
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Entity Type | Organization
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Legal Business Name | CHARLES G. LANGHAM III, M.D., P.A.
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Dates
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Enumeration Date | 09/23/2008
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Last Update Date | 09/23/2008
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Provider Practice Location Address
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Address Line | 1307 8TH AVE 201
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City | FORT WORTH
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State | TX
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Zip | 76104-4137
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Country | US
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Telephone | 817-921-6091
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Fax | 817-921-9163
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Provider Business Mailing Address
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Address Line | 1307 8TH AVE 201
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City | FORT WORTH
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State | TX
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Zip | 76104-4137
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Country | US
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Telephone | 817-921-6091
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Fax | 817-921-9163
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CHARLES G. LANGHAM III
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Credential | M.D., P.A.
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Telephone | 817-921-6091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | E4467
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License Number State | TX
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