Basic Information
Provider Information | |||||||||
NPI: | 1770896763 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LANGLEY | ||||||||
FirstName: | RHET | ||||||||
MiddleName: | R | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3283 MALCOLM DR | ||||||||
Address2: |   | ||||||||
City: | MONTGOMERY | ||||||||
State: | AL | ||||||||
PostalCode: | 361168816 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3343569970 | ||||||||
FaxNumber: | 3342698783 | ||||||||
Practice Location | |||||||||
Address1: | 3283 MALCOLM DR | ||||||||
Address2: |   | ||||||||
City: | MONTGOMERY | ||||||||
State: | AL | ||||||||
PostalCode: | 361168816 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3343569970 | ||||||||
FaxNumber: | 3342698783 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/19/2010 | ||||||||
LastUpdateDate: | 04/06/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 33581 | AL | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology |   | 207LP2900X | 33581 | AL | N |   | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.