Provider Demographics
NPI:1336373307
Name:ROBBINS, LANGAN PHELPS (DO)
Entity type:Individual
Prefix:
First Name:LANGAN
Middle Name:PHELPS
Last Name:ROBBINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MOUNT TENJO AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA RITA
Mailing Address - State:GU
Mailing Address - Zip Code:96915-1428
Mailing Address - Country:US
Mailing Address - Phone:671-788-5538
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL GUAM
Practice Address - Street 2:BLDG 50 FAHRENHOLT
Practice Address - City:AGANA HEIGHTS
Practice Address - State:GU
Practice Address - Zip Code:96910
Practice Address - Country:US
Practice Address - Phone:671-344-9765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01022022612085R0202X, 208D00000X
CT622862085R0202X
NJ25MB105989002085R0202X, 208D00000X
GUDO-00762085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUH109961Medicaid