Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | C34891 | CA |
NPI | 1003865064 |
---|---|
Provider Name | Douglas Lange |
First Address | Walnut Creek, CA 94598-8396 |
Second Address | Walnut Creek, CA 94598-2444 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 17/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A35760 | (02) | CA |