Provider Demographics
NPI:1699931253
Name:LONGOBARDI, JAIME LYN (DO)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:LYN
Last Name:LONGOBARDI
Suffix:
Gender:F
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:UNIT 100207 BOX 1
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96673-0700
Mailing Address - Country:US
Mailing Address - Phone:808-653-2191
Mailing Address - Fax:
Practice Address - Street 1:USS NEW ORLEANS
Practice Address - Street 2:UNIT 100207 #1
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96673-0700
Practice Address - Country:US
Practice Address - Phone:808-653-2191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202484208D00000X
286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA39020000XOtherINTERN TRAINING LICENSE