Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 5101019826 | MI |
Y | 2080P0203X | Pediatric Critical Care Doctor | 02005311A | IN |
NPI | 1194081067 |
---|---|
Provider Name | David Anthony Lankford |
First Address | Fort Wayne, IN 46804-7934 |
Second Address | Fort Wayne, IN 46804-4140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2012 |
Last Update Date | 13/10/2020 |