Healthcare Provider Details

I. General information

NPI: 1912077025
Provider Name (Legal Business Name): DARRYL C LONGEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date: 11/11/2008
Reactivation Date: 11/26/2008

III. Provider practice location address

7355 BARLITE BLVD SUITE 201
SAN ANTONIO TX
78224-1342
US

IV. Provider business mailing address

7355 BARLITE BLVD SUITE 201
SAN ANTONIO TX
78224-1342
US

V. Phone/Fax

Practice location:
  • Phone: 210-928-7538
  • Fax: 210-921-2552
Mailing address:
  • Phone: 210-928-7538
  • Fax: 210-921-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number42330
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: