Basic Information
| Provider Information | |||||||||
| NPI: | 1013903640 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANGSTON | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1885 MAIN ST | ||||||||
| Address2: | #407 | ||||||||
| City: | WAILUKU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967931819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082445513 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 221 MAHALANI ST | ||||||||
| Address2: | |||||||||
| City: | WAILUKU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967932526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082422290 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 06/17/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 00026726 | AL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD-13539 | HI | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7820686 | 01 | AL | AETNA | OTHER | 051530205 | 01 | AL | BCBS PROVIDER NUMBER | OTHER | 626749 | 05 | HI | MEDICAID | 0000281071 | 01 | HI | BLUECROSSBLUESHIELD | OTHER | 009935826 | 05 | AL | MEDICAID | 051556498 | 05 | AL | MEDICAID |