| Doctor Name: | DR. TIMOTHY LEE LONGACRE |
| NPI Number: | 1659433712 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 17200 |
| Business Practice Address: | 2501 Capehart Rd Offutt Afb, NE - 681131043 |
| Business Phone Number: | 4025914503 |
| Business Fax Number: | 4025914519 |
| Mailing Address: | 13018 Charles St, OMAHA |
| State: | NE |
| Postal Code: | 681541091 |
| Phone Number: | 4023594410 |
| Fax Number: | 4024523018 |
| NPI Enumeration Date: | 12/15/2006 |
| NPI Last Update Date: | 03/18/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 17200 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NE |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |