Provider Demographics
NPI:1346476785
Name:LONGANECKER, CHARLES RAY II (PA-C)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:RAY
Last Name:LONGANECKER
Suffix:II
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32665 US HIGHWAY 281 N
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-3124
Mailing Address - Country:US
Mailing Address - Phone:830-980-1350
Mailing Address - Fax:
Practice Address - Street 1:32665 US HIGHWAY 281 N
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-3124
Practice Address - Country:US
Practice Address - Phone:830-980-1350
Practice Address - Fax:830-438-3423
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical