Provider Demographics
NPI:1518921303
Name:LONGWILL, DEBORAH (DO PA)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:LONGWILL
Suffix:
Gender:F
Credentials:DO PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 SW 104TH ST
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3149
Mailing Address - Country:US
Mailing Address - Phone:305-279-7546
Mailing Address - Fax:305-279-4180
Practice Address - Street 1:7700 SW 104TH ST
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-3149
Practice Address - Country:US
Practice Address - Phone:305-279-7546
Practice Address - Fax:305-279-4180
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0005683207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF30068Medicare UPIN