Provider Demographics
NPI:1477877264
Name:LONGMIRE, DAVID ALLAN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALLAN
Last Name:LONGMIRE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1777 GLENMORE AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-1232
Mailing Address - Country:US
Mailing Address - Phone:225-933-5454
Mailing Address - Fax:
Practice Address - Street 1:7777 HENNESSY BLVD STE 701
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4370
Practice Address - Country:US
Practice Address - Phone:225-765-5864
Practice Address - Fax:225-765-2013
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2018-10-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA207480207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine