Individual
MR. CARL W LANGE IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1337 S SAM HOUSTON BLVD, HOUSTON, MO 65483-2046
(417) 967-5435
(417) 967-5503
Mailing address
1337 S SAM HOUSTON BLVD, HOUSTON, MO 65483-2046
(417) 967-5435
(417) 967-5503
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2014004500
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700200458
—
MO
01
—
26D0889777
CLIA
MO
Enumeration date
02/14/2014
Last updated
02/14/2014
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