Provider Demographics
NPI:1518906742
Name:LONG, JAMES WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WALTER
Last Name:LONG
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-713-9900
Mailing Address - Fax:405-713-9920
Practice Address - Street 1:3400 NW EXPRESSWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4491
Practice Address - Country:US
Practice Address - Phone:405-713-9900
Practice Address - Fax:405-713-9920
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2017-04-05
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Provider Licenses
StateLicense IDTaxonomies
UT1819031205208G00000X
OK26154208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTF37278Medicare UPIN
UTF37278Medicare UPIN