Provider Demographics
NPI:1477555753
Name:LONGO, GERNON A (MD)
Entity Type:Individual
Prefix:DR
First Name:GERNON
Middle Name:A
Last Name:LONGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:111 S 90TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3907
Mailing Address - Country:US
Mailing Address - Phone:402-397-9800
Mailing Address - Fax:402-397-7591
Practice Address - Street 1:7710 MERCY RD
Practice Address - Street 2:STE 608
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2346
Practice Address - Country:US
Practice Address - Phone:402-399-8166
Practice Address - Fax:402-399-0718
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12465208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEB68137Medicare UPIN
NE269924Medicare ID - Type Unspecified