Doctor Name: | DR. MAYNARD F. LANG |
NPI Number: | 1396720355 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | C29340 |
Business Practice Address: | 782 East Harding Way Stockton, CA - 952056101 |
Business Phone Number: | 2094755500 |
Business Fax Number: | 2094661982 |
Mailing Address: | 3400 Data Drive, Physician Support Services, 2nd Floor RANCHO CORDOVA |
State: | CA |
Postal Code: | 956707956 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 12/13/2005 |
NPI Last Update Date: | 07/02/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | C29340 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |