Individual
THEODORE E LANGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 W FORT ST., # 111, BOISE, ID 83702
(208) 422-1325
(208) 422-1319
Mailing address
500 W FORT ST., # 111, BOISE, ID 83702
(208) 422-1325
(208) 422-1319
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
M-9049
ID
Other
Enumeration date
07/20/2006
Last updated
04/19/2022
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