Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 6460 | OK |
Y | 213EG0000X | General Practice | 6460 | OK |
N | 1223G0001X | General Practice | DD3238 | NM |
N | 213EG0000X | General Practice | DD3238 | NM |
NPI | 1003045469 |
---|---|
Provider Name | Dr. Leta Langford |
First Address | Edmond, OK 73013-1772 |
Second Address | Moore, OK 73160 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2009 |
Last Update Date | 19/03/2014 |