MEDICARE: DR. CAROLYN LANGFORD UROLOGIC SOLUTIONS, LLC

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	208800000X	Urology Physician

General Provider Information

NPI Number	:	1366916843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. CAROLYN LANGFORD UROLOGIC SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	9400 GLADIOLUS DR STE 30
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-9615
Country	:	US
Telephone Number	:	239-221-0992
Fax Number	:

Provider Business Practice Location Address
First Line	:	9400 GLADIOLUS DR STE 30
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-9615
Country	:	US
Telephone Number	:	239-221-0992
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CAROLYN LANGFORD
Credential	:	DO
Telephone Number	:	239-221-0992

Provider Enumeration Date	:	01/17/2019
Last Update Date	:	01/17/2019

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