Provider Demographics
NPI:1447433867
Name:LANGLOIS, MARY LOUISE (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LOUISE
Last Name:LANGLOIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARYLOU
Other - Middle Name:
Other - Last Name:MOYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2575 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-3806
Mailing Address - Country:US
Mailing Address - Phone:303-449-3594
Mailing Address - Fax:303-449-3112
Practice Address - Street 1:2575 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-3806
Practice Address - Country:US
Practice Address - Phone:303-449-3594
Practice Address - Fax:303-449-3112
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31795207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COF30549Medicare UPIN