Provider Demographics
NPI:1538111679
Name:DEBORAH LONGWILL DO PA
Entity Type:Organization
Organization Name:DEBORAH LONGWILL DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:LONGWILL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-279-7546
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5683207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF30068Medicare UPIN