| Doctor Name: | DOUG LONGO |
| NPI Number: | 1003276866 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | APRN |
| License Number: | 2016006780 |
| Business Practice Address: | 3635 Vista Ave Saint Louis, MO - 631102539 |
| Business Phone Number: | 3145778773 |
| Business Fax Number: | 3142685200 |
| Mailing Address: | 3635 Vista Ave, SAINT LOUIS |
| State: | MO |
| Postal Code: | 631102539 |
| Phone Number: | 3145778773 |
| Fax Number: | 3142685200 |
| NPI Enumeration Date: | 03/07/2016 |
| NPI Last Update Date: | 03/07/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2100X |
| License Number: | 2016006780 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Acute Care |
| Taxonomy Definition: | |