Provider Demographics
NPI:1366557407
Name:LANGSTON, ROBERT L (CRNA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:LANGSTON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 W 850 S
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-2198
Mailing Address - Country:US
Mailing Address - Phone:801-733-2155
Mailing Address - Fax:
Practice Address - Street 1:3460 PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-2049
Practice Address - Country:US
Practice Address - Phone:801-993-9526
Practice Address - Fax:801-733-5872
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT212994-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT24053OtherPEHP
UTPR00660OtherMOLINA
ID004373400Medicaid
WY117819900Medicaid
UT350411OtherDESERET MUTUAL
UT53000OtherHEALTHY U
UT870532396LA1OtherEDUCATORS MUTUAL
UT190400800OtherUS DEPT OF LABOR
UTQM0000023694OtherALTIUS
UT2000012OtherUNITED HEALTHCARE
KS200611540AMedicaid
UT2000012OtherUNITED HEALTHCARE
UT190400800OtherUS DEPT OF LABOR
UT870532396LA1OtherEDUCATORS MUTUAL
UT430032739Medicare ID - Type UnspecifiedRAILROAD MEDICARE