Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 4044 | AZ |
Y | 213ER0200X | Radiology | 4044 | AZ |
NPI | 1578606323 |
---|---|
Provider Name | Dr. Gary Andrew Longmuir |
First Address | Mesa, AZ 85207-1429 |
Second Address | Phoenix, AZ 85014-2707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 08/07/2007 |