Basic Information
| Provider Information | |||||||||
| NPI: | 1194010389 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANG | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3951 NW 48TH TER | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326067228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522655230 | ||||||||
| FaxNumber: | 3522655231 | ||||||||
| Practice Location | |||||||||
| Address1: | 3951 NW 48TH TER | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326067228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522655230 | ||||||||
| FaxNumber: | 3522655231 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2011 | ||||||||
| LastUpdateDate: | 12/24/2014 | ||||||||
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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 | 207Q00000X | TRN16060 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ME119870 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 012357800 | 05 | FL | MEDICAID |