Individual
DR. TARA ANN LONGORIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3911 AVENUE B, SUITE 1100, SCOTTSBLUFF, NE 69361-4617
(308) 630-2100
(308) 630-2113
Mailing address
18 SITZMAN CT, SCOTTSBLUFF, NE 69361-4697
(308) 632-6310
(308) 630-2113
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
470788581
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080165023
PALMENTO GBA RR MEDICARE
—
Enumeration date
07/31/2006
Last updated
02/10/2014
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