Provider Demographics
NPI:1306898853
Name:JAMES LONGTON DPM PC
Entity type:Organization
Organization Name:JAMES LONGTON DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:LONGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:480-212-2959
Mailing Address - Street 1:3217 E SHEA BLVD
Mailing Address - Street 2:#503
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3301
Mailing Address - Country:US
Mailing Address - Phone:480-212-2959
Mailing Address - Fax:866-598-4832
Practice Address - Street 1:5555 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4622
Practice Address - Country:US
Practice Address - Phone:480-212-2959
Practice Address - Fax:866-598-4832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ639213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ084639Medicaid
AZ1245288950OtherINDIVIDUAL NPI
AZAZ0910520OtherBCBS OF AZ
AZP00340466OtherRR MEDICARE
AZV08986Medicare UPIN
AZ084639Medicaid
AZ109507Medicare PIN