Provider Demographics
NPI:1033191408
Name:LONG, CURTIS W (DPM)
Entity Type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:W
Last Name:LONG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:120 E BIRCH ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3054
Mailing Address - Country:US
Mailing Address - Phone:509-529-7800
Mailing Address - Fax:509-529-0835
Practice Address - Street 1:120 E BIRCH ST
Practice Address - Street 2:SUITE 11
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3054
Practice Address - Country:US
Practice Address - Phone:509-529-7800
Practice Address - Fax:509-529-0835
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPO00000225213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT03110Medicare UPIN
1039780001Medicare NSC