Provider Demographics
NPI:1083606602
Name:LONGO, JAMES F (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:F
Last Name:LONGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 HEATHER CT
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-9738
Mailing Address - Country:US
Mailing Address - Phone:805-434-1859
Mailing Address - Fax:209-549-9385
Practice Address - Street 1:274 HEATHER CT
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9738
Practice Address - Country:US
Practice Address - Phone:805-434-1859
Practice Address - Fax:805-434-2383
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG508812085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00316522OtherRAILROAD MEDICARE
CA00G508810Medicaid
CA00G508810Medicaid