| Doctor Name: | BROOKE A LANGE |
| NPI Number: | 1093103038 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 50.004109 |
| Business Practice Address: | 801 Pro Dr Ste D2 James Reichert Do, General & Bariatric Surgery Celina, OH - 458223307 |
| Business Phone Number: | 4193943387 |
| Business Fax Number: | 4195868574 |
| Mailing Address: | 200 Saint Clair Ave, Jtdm Family Practice, Llc SAINT MARYS |
| State: | OH |
| Postal Code: | 458852400 |
| Phone Number: | 4193943387 |
| Fax Number: | 4195868509 |
| NPI Enumeration Date: | 12/29/2014 |
| NPI Last Update Date: | 07/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 50.004109 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |