Provider Demographics
NPI:1194821868
Name:LONG, JAMES MELVIN (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MELVIN
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1200 B GALE WILSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3552
Mailing Address - Country:US
Mailing Address - Phone:707-646-5611
Mailing Address - Fax:707-646-4902
Practice Address - Street 1:1020 NUT TREE RD STE 390
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-4100
Practice Address - Country:US
Practice Address - Phone:707-624-8000
Practice Address - Fax:707-624-8001
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2023-12-21
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Provider Licenses
StateLicense IDTaxonomies
CAC50016207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC50016OtherMEDICAL LICENSE