Provider Demographics
NPI:1750612180
Name:PETER H LANGSJOEN MD PA
Entity type:Organization
Organization Name:PETER H LANGSJOEN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:HARALD
Authorized Official - Last Name:LANGSJOEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-595-3778
Mailing Address - Street 1:1107 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2124
Mailing Address - Country:US
Mailing Address - Phone:903-595-3778
Mailing Address - Fax:903-595-4962
Practice Address - Street 1:1107 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2124
Practice Address - Country:US
Practice Address - Phone:903-595-3778
Practice Address - Fax:903-595-4962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6857174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1103699-01Medicaid
TX1103699-01Medicaid