Basic Information
| Provider Information | |||||||||
| NPI: | 1821185703 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANINGHAM | ||||||||
| FirstName: | RODNEY | ||||||||
| MiddleName: | JASON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4015 INTERSTATE 45 N | ||||||||
| Address2: | |||||||||
| City: | CONROE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773044901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9367566631 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4015 INTERSTATE 45 N | ||||||||
| Address2: | |||||||||
| City: | CONROE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773044901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9367566631 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 03/09/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | K2943 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 042304801 | 05 | TX | MEDICAID |