Provider Demographics
NPI:1457311557
Name:LONG, WILLIAM LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LAWRENCE
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42441-0042
Mailing Address - Country:US
Mailing Address - Phone:270-886-4556
Mailing Address - Fax:270-707-9650
Practice Address - Street 1:100 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:KY
Practice Address - Zip Code:42445-0410
Practice Address - Country:US
Practice Address - Phone:270-365-0442
Practice Address - Fax:270-365-6528
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY182712085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP 64182710Medicaid
1786607OtherACR MEMBERSHIP #
KY64182710Medicaid
300117516OtherRAILROAD MEDICARE
KY000000185273OtherBLUE CROSS/BLUE SHIELD
KY18271OtherMEDICAL LICENSE
TNM05431OtherMEDICAL LICENSE
KYP 1859701Medicare ID - Type Unspecified
KY64182710Medicaid
300117516OtherRAILROAD MEDICARE