Individual
JORY D LANGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8038 WURZBACH RD, SUITE 270, SAN ANTONIO, TX 78229-3817
(210) 616-0866
(210) 616-0868
Mailing address
3711 MARY MONT DR, SAN ANTONIO, TX 78217-3415
(210) 616-0866
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
E6121
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
120215205
—
TX
01
—
300018335
RR MEDICARE
TX
Enumeration date
07/13/2005
Last updated
07/24/2008
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