1801917646 NPI number — DR. WILLIAM BROOKS LANGSTON III

Table of content: DR. WILLIAM BROOKS LANGSTON III (NPI 1801917646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801917646 NPI number — DR. WILLIAM BROOKS LANGSTON III

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANGSTON
Provider First Name:
WILLIAM
Provider Middle Name:
BROOKS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
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:
1801917646
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3635 N. BELTLINE ROAD
Provider Second Line Business Mailing Address:
SUITE 160
Provider Business Mailing Address City Name:
SUNNYVALE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75182
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-270-6533
Provider Business Mailing Address Fax Number:
972-270-6578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18601 LYNDON B JOHNSON FWY
Provider Second Line Business Practice Location Address:
SUITE 625
Provider Business Practice Location Address City Name:
MESQUITE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75150-5600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-270-6533
Provider Business Practice Location Address Fax Number:
972-270-6578
Provider Enumeration Date:
04/02/2007

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: 1223G0001X , with the licence number:  10610 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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