Provider Demographics
NPI:1093718439
Name:LONG, WILLIAM JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JEFFREY
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1051 GAUSE BLVD
Mailing Address - Street 2:STE 320
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2988
Mailing Address - Country:US
Mailing Address - Phone:985-726-2655
Mailing Address - Fax:985-643-9808
Practice Address - Street 1:1051 GAUSE BLVD
Practice Address - Street 2:STE 320
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2988
Practice Address - Country:US
Practice Address - Phone:985-726-2655
Practice Address - Fax:985-643-9808
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2010-03-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA017055207RC0000X
NH7248207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09013682Medicaid
LA1389480Medicaid
LA1389480Medicaid
B77213Medicare UPIN