1336373307 NPI number — LANGAN PHELPS ROBBINS D.O.

Table of content: LANGAN PHELPS ROBBINS D.O. (NPI 1336373307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336373307 NPI number — LANGAN PHELPS ROBBINS D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBBINS
Provider First Name:
LANGAN
Provider Middle Name:
PHELPS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336373307
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 MOUNT TENJO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA RITA
Provider Business Mailing Address State Name:
GU
Provider Business Mailing Address Postal Code:
96915-1428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
671-788-5538
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NAVAL HOSPITAL GUAM
Provider Second Line Business Practice Location Address:
BLDG 50 FAHRENHOLT
Provider Business Practice Location Address City Name:
AGANA HEIGHTS
Provider Business Practice Location Address State Name:
GU
Provider Business Practice Location Address Postal Code:
96910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
671-344-9765
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/06/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  0102202261 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 62286 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 25MB10598900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 0102202261 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 25MB10598900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: DO-0076 , registered in the state of GU ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: H109961 , issued by the state of ( GU ) . This identifiers is of the category "MEDICAID".