Provider Demographics
NPI:1043251473
Name:LANGEVIN, PAUL N (DO)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:N
Last Name:LANGEVIN
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 1:3541 TRAPPERS TRL
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-4278
Mailing Address - Country:US
Mailing Address - Phone:307-265-2177
Mailing Address - Fax:
Practice Address - Street 1:2000 CAMPBELL DR
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-1528
Practice Address - Country:US
Practice Address - Phone:307-534-7165
Practice Address - Fax:307-532-5381
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7380A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW23194Medicare PIN
WYW21626Medicare PIN
WYW21808Medicare PIN