Provider Demographics
NPI:1326049263
Name:LONGNECKER, JOSEPH MILTON (DO)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MILTON
Last Name:LONGNECKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1041 E. YORBA LINDA BLVD.
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-0000
Mailing Address - Country:US
Mailing Address - Phone:714-577-9500
Mailing Address - Fax:714-577-9504
Practice Address - Street 1:1041 E. YORBA LINDA BLVD.
Practice Address - Street 2:SUITE 306
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-0000
Practice Address - Country:US
Practice Address - Phone:714-577-9500
Practice Address - Fax:714-577-9504
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB58230207Q00000X
CA20A3180208000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB58230Medicare UPIN
DD751AMedicare PIN