Lange, John Leslie

Lange, John Leslie is an individual health care provider with primary practice located at 5500 Ellsworth Rd. , Fort Smith AR 72903-3222. He recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as his primary health care specialty. Lange, John Leslie can be contacted via phone (479) 242-2411.

Contact Information

Primary practice address
5500 Ellsworth Rd. Fort Smith AR 72903-3222
Phone: (479) 242-2411
Fax: (479) 242-2412
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Urology 208800000X N6768 Arkansas

Profile Details

NPI number 1154382802
LBN Legal business name Lange, John Leslie
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 31st, 2006
Last updated Mar 22nd, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154382802 NPPES
Arkansas MEDICAID 105907001
Arkansas MEDICAID 100134360A
Arkansas Other 53049

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