Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 1751281205 | UT |
N | 207QS0010X | Family Doctor - Sports Medicine | 1751281205 | UT |
NPI | 1093730129 |
---|---|
Provider Name | James P. Longe |
First Address | Salt Lake City, UT 84121-6923 |
Second Address | Salt Lake City, UT 84121-6923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D26515 | (02) | UT |