Provider Demographics
NPI:1134110257
Name:LONG, BRIAN MCKINLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MCKINLEY
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 1:5500 DEMOCRACY DR STE 150
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-4202
Mailing Address - Country:US
Mailing Address - Phone:972-494-3100
Mailing Address - Fax:972-608-0005
Practice Address - Street 1:5425 W SPRING CREEK PKWY STE 140
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-4318
Practice Address - Country:US
Practice Address - Phone:972-494-3100
Practice Address - Fax:972-608-0005
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD036212208600000X
TXL1374208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
521467441OtherJHCP TAX ID
236309YF9VMedicare PIN
I28557Medicare UPIN
521467441OtherJHCP TAX ID