Provider Demographics
NPI:1437467909
Name:LONG, PATRICK MCLEAN II (LAC MACOM)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:MCLEAN
Last Name:LONG
Suffix:II
Gender:M
Credentials:LAC MACOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3939 E WASHITA ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65809-2938
Mailing Address - Country:US
Mailing Address - Phone:417-882-0796
Mailing Address - Fax:
Practice Address - Street 1:2644 S GLENSTONE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-3712
Practice Address - Country:US
Practice Address - Phone:417-886-2063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-18
Last Update Date:2010-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009022888171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist