Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 45667 | AZ |
N | 207L00000X | Anesthesiologist | MD059648L | PA |
NPI | 1003894916 |
---|---|
Provider Name | Dr. David Bruce Longenecker |
First Address | Tucson, AZ 85719-2380 |
Second Address | Tucson, AZ 85719-2380 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2006 |
Last Update Date | 10/02/2016 |