Provider Demographics
NPI:1053476903
Name:LONGFELLOW, THOMAS RUDY (DO)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RUDY
Last Name:LONGFELLOW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5769 E DIONYSUS DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85232-5599
Mailing Address - Country:US
Mailing Address - Phone:520-723-6355
Mailing Address - Fax:
Practice Address - Street 1:5769 E DIONYSUS DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85232-5599
Practice Address - Country:US
Practice Address - Phone:520-723-6355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4106207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine