Provider Demographics
NPI:1255309548
Name:LONG, JAMES W (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
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:PO BOX 11230
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-1230
Mailing Address - Country:US
Mailing Address - Phone:479-709-6700
Mailing Address - Fax:479-709-6751
Practice Address - Street 1:3501 WE KNIGHT DR
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-7994
Practice Address - Country:US
Practice Address - Phone:479-709-6700
Practice Address - Fax:479-709-6751
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2078207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1372578OtherCIGNA
OK100083360AOtherOKLAHOMA MEDICAID
AR4613325OtherAETNA
AR15472000000OtherQUALCHOICE
AR920001OtherUNITED HEALTHCARE
AR200038805OtherRAILROAD MEDICARE
AR53200OtherARKANSAS BLUE CROSS
AR105614001Medicaid
AR904208OtherUSA MCO
AR200038805OtherRAILROAD MEDICARE
AR105614001Medicaid