Active NPI
Thomas Rudy Longfellow, D.O.
- Family Medicine Physician
- Florence, AZ
National Provider Identifier
1053476903
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 4106
- Practice address
- 5769 E Dionysus Dr
Florence, AZ 85232-5599 - Phone
- (520) 723-6355
- NPI assigned
- Dec 22, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4106 | AZ | Primary |
Addresses
Primary practice location
5769 E Dionysus Dr
Florence, AZ 85232-5599
Mailing address
5769 E Dionysus Dr
Florence, AZ 85232-5599
Phone (520) 723-6355
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4106 | AZ | MD | Oral and Maxillofacial Surgery (Dentist) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1241740800000",
"number": "1053476903",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5769 E DIONYSUS DR",
"city": "FLORENCE",
"state": "AZ",
"postal_code": "852325599",
"telephone_number": "520-723-6355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5769 E DIONYSUS DR",
"city": "FLORENCE",
"state": "AZ",
"postal_code": "852325599",
"telephone_number": "520-723-6355"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONGFELLOW",
"first_name": "THOMAS",
"middle_name": "RUDY",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-22",
"last_updated": "2009-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AZ",
"license": "4106",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Florence, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.