Provider Demographics
NPI:1013942374
Name:LONGSHAW, KEVIN M (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:LONGSHAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9528 WEBB CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-4938
Mailing Address - Country:US
Mailing Address - Phone:214-357-7311
Mailing Address - Fax:214-352-8150
Practice Address - Street 1:9528 WEBB CHAPEL RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-4938
Practice Address - Country:US
Practice Address - Phone:214-357-7311
Practice Address - Fax:214-352-8150
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1242207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX043606502Medicaid
TX043606503Medicaid
TX043606503Medicaid
TXG37420Medicare UPIN