Provider Demographics
NPI:1376745745
Name:LONG, JEREME (DO)
Entity Type:Individual
Prefix:
First Name:JEREME
Middle Name:
Last Name:LONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARL R. DARNALL ARMY MEDICAL CENTER
Mailing Address - Street 2:36000 DARNALL LOOP
Mailing Address - City:FT. HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CARL R. DARNALL ARMY MEDICAL CENTER
Practice Address - Street 2:36000 DARNALL LOOP
Practice Address - City:FT. HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-288-8303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine