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General NPI Number Information
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NPI Number | 1841607678
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Entity Type | Individual
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Provider Name | BRIAN SCOTT LANG PA
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Gender | Male
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Dates
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Enumeration Date | 07/14/2014
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Last Update Date | 12/11/2019
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Provider Practice Location Address
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Address Line | 1717 N E ST STE 205
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City | PENSACOLA
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State | FL
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Zip | 32501-6336
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Country | US
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Telephone | 850-437-8810
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Fax | 850-437-8809
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Provider Business Mailing Address
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Address Line | PO BOX 17567
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City | PENSACOLA
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State | FL
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Zip | 32522-7567
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9107954
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License Number State | FL
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