Provider Demographics
NPI:1326278912
Name:LONGMUIR, MARK KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:KENNETH
Last Name:LONGMUIR
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:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:ND
Mailing Address - Zip Code:58784
Mailing Address - Country:US
Mailing Address - Phone:701-628-2424
Mailing Address - Fax:701-628-3274
Practice Address - Street 1:615 6TH ST SE
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:ND
Practice Address - Zip Code:58784-4444
Practice Address - Country:US
Practice Address - Phone:701-628-2424
Practice Address - Fax:701-628-3274
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND12233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine