Basic Information
| Provider Information | |||||||||
| NPI: | 1578923033 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LANGDON | ||||||||
| FirstName: | PHILLIP | ||||||||
| MiddleName: | NEIL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7296 SHADY GROVE RD | ||||||||
| Address2: | |||||||||
| City: | GRAND RIDGE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324423744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2392733638 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1300 MICCOSUKEE RD | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323085054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504311155 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2016 | ||||||||
| LastUpdateDate: | 02/26/2016 | ||||||||
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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 | 363AM0700X | PAT9109345 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.