Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DN11114 | FL |
NPI | 1093744823 |
---|---|
Provider Name | Dr. John P. Longmire III |
First Address | Tampa, FL 33612-3310 |
Second Address | Tampa, FL 33612-3310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2006 |
Last Update Date | 08/07/2007 |