Most Relevant Information
Provider Data
| NPI Number: | 1003276866 |
| Provider Name: | DOUG LONGO APRN |
| Entity Type: | Individual |
| Taxonomy Code: | 363LA2100X |
| Specialty: | Nurse Practitioner |
| License Number: | 2016006780 |
Most Important Dates
| Enumeration Date: | 03/07/2016 |
| Last Updated: | 10/30/2020 |
Provider Practice Location
1201 S GRAND BLVD
SAINT LOUIS
MO
631041016
Practice Location Phone/Fax
| Phone: | 3142578000 |
| Fax: | 3149771877 |
Provider Mailing Location
1008 S SPRING AVE
SAINT LOUIS
MO
631102520
Provider Mailing Phone/Fax
| Phone: | 3149774740 |
| Fax: | 3149771877 |