Individual
FORREST JOHN LONGWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
9040 JACKSON AVE, TACOMA, WA 98431-1000
(253) 968-3066
Mailing address
9040 JACKSON AVE, JOINT BASE LEWIS MCCHORD, WA 98431-1000
(253) 968-2252
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
OP61532252
WA
208D00000X
General Practice Physician
2088
NE
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/01/2018
Last updated
04/19/2024
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