Individual
DR. TIMOTHY LEE LONGACRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2501 CAPEHART RD, OFFUTT AFB, NE 68113-1043
(402) 591-4503
(402) 591-4519
Mailing address
13018 CHARLES ST, OMAHA, NE 68154-1091
(402) 359-4410
(402) 452-3018
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
17200
NE
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
17200
NE
208D00000X
General Practice Physician
17200
NE
Other
Enumeration date
12/15/2006
Last updated
03/18/2013
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