Provider Demographics
NPI:1396701413
Name:LANGSDON, PHILLIP R (MD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:R
Last Name:LANGSDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:66 N PAULINE ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-5105
Mailing Address - Country:US
Mailing Address - Phone:901-448-7642
Mailing Address - Fax:901-448-8015
Practice Address - Street 1:1910 NONCONNAH BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38132-2113
Practice Address - Country:US
Practice Address - Phone:901-448-2300
Practice Address - Fax:901-448-6657
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2007-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN16885207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3021123Medicaid
TN3021129Medicare PIN
A98491Medicare UPIN