Individual
DR. JOHN LESLIE LANGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5500 ELLSWORTH RD., FORT SMITH, AR 72903-3222
(479) 242-2411
(479) 242-2412
Mailing address
PO BOX 402319, ATLANTA, GA 30384-2319
(479) 709-7399
(479) 709-7053
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
N6768
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100134360A
—
OK
05
—
105907001
—
AR
01
—
53049
BLUE CROSS
AR
Enumeration date
03/31/2006
Last updated
03/22/2013
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