Provider Demographics
NPI:1437174620
Name:LONG, DAVID DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DEAN
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 1:910 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-2928
Mailing Address - Country:US
Mailing Address - Phone:432-714-4650
Mailing Address - Fax:432-714-4653
Practice Address - Street 1:910 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-2928
Practice Address - Country:US
Practice Address - Phone:432-714-4650
Practice Address - Fax:432-714-4653
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0574207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8AJ774OtherBLUE CROSS BLUE SHIELD
TX1797250-01Medicaid
TXDE4229OtherRAILROAD
TXC18512Medicare UPIN
TX1797250-01Medicaid