Individual
MR. MARK RALPH LONQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13555 W MCDOWELL RD, #103, GOODYEAR, AZ 85395
(623) 925-1157
(623) 932-1045
Mailing address
3815 E BELL RD STE 2200, PHOENIX, AZ 85032-2139
(602) 633-3838
(602) 633-3845
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22778
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
188210
AHCCCS
AZ
Enumeration date
09/23/2005
Last updated
04/18/2019
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