Provider Demographics
NPI:1972565554
Name:LANGE, GLADYS ELISA (MD)
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:ELISA
Last Name:LANGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3917 WEST RD
Mailing Address - Street 2:STE 150
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-5303
Mailing Address - Country:US
Mailing Address - Phone:505-662-4351
Mailing Address - Fax:505-662-2932
Practice Address - Street 1:8440 WALNUT HILL LN
Practice Address - Street 2:SUITE 350
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3833
Practice Address - Country:US
Practice Address - Phone:214-373-1773
Practice Address - Fax:214-373-1316
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2018-06-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH0544207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110323601Medicaid
TX110323601Medicaid