Provider Demographics
NPI:1083773428
Name:LONG, CLINTON ARVIN (MD)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:ARVIN
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 N FM 1417
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-2351
Mailing Address - Country:US
Mailing Address - Phone:903-892-2020
Mailing Address - Fax:903-892-0633
Practice Address - Street 1:2203 N FM 1417
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-2351
Practice Address - Country:US
Practice Address - Phone:903-892-2020
Practice Address - Fax:903-892-0633
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5338207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7057235OtherAETNA
TX8G9440OtherBCBS OF TEXAS
TX142713002Medicaid
TX180045779OtherRAILROAD MEDICARE
TX8A1375Medicare ID - Type Unspecified
TX7057235OtherAETNA