MEDICARE: MR. ROBERT RANDALL LANG PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1134452402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT RANDALL LANG PA-C

Provider Business Mailing Address
First Line	:	1160 E SAINT CLAIR ST
Second Line	:
City	:	VINCENNES
State	:	IN
Zip	:	47591-4853
Country	:	US
Telephone Number	:	812-885-3325
Fax Number	:	812-885-8987

Provider Business Practice Location Address
First Line	:	1813 WILLOW ST STE 3
Second Line	:
City	:	VINCENNES
State	:	IN
Zip	:	47591-4276
Country	:	US
Telephone Number	:	812-885-8941
Fax Number	:	812-885-8940

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2009
Last Update Date	:	09/03/2024

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