Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 16885 | TN |
NPI | 1396701413 |
---|---|
Provider Name | Dr. Phillip R Langsdon |
First Address | Memphis, TN 38105-5105 |
Second Address | Memphis, TN 38132-2113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 06/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3021123 | (05) | TN |
A98491 | (02) |