Provider Demographics
NPI:1285794552
Name:LANG, PATRICK BARDE (PA-C)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:BARDE
Last Name:LANG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7495 SOUTH. STATE STREET
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047
Mailing Address - Country:US
Mailing Address - Phone:801-213-9400
Mailing Address - Fax:
Practice Address - Street 1:7495 SOUTH. STATE STREET
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047
Practice Address - Country:US
Practice Address - Phone:801-213-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT377086-8906OtherUTAH DOPL PA CONTROL SUB
UTTPRA08420OtherMOLINDA HEALTHCARE OF UT
UT377086-1206OtherUT DPOL PA