MR. Carl W Lange IV, PA

NPI #1700200458 in Houston, Missouri

Provider Information

NPI Number: 1700200458
Entity Type: Individual
Name: MR. Carl W Lange IV, PA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA
Enumeration Date: Feb 14, 2014
Last Updated: Feb 14, 2014

Practice Location

Address: 1337 S SAM HOUSTON BLVD
City: Houston
State: Missouri
ZIP Code: 65483-2046
Phone: (417) 967-5435

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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