Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | DPM0000000520 | TN |
NPI | 1043207988 |
---|---|
Provider Name | Vincent B Longobardo |
First Address | Crossville, TN 38557-0008 |
Second Address | Crossville, TN 38555-7654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2005 |
Last Update Date | 27/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3352893 | (05) | TN |
U64759 | (02) | TN |