Provider Demographics
NPI:1558499319
Name:LONG, NATHAN PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:PAUL
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7929 BROOKRIVER DR. STE. 165
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:85247
Mailing Address - Country:US
Mailing Address - Phone:214-631-5664
Mailing Address - Fax:214-631-5665
Practice Address - Street 1:7929 BROOKRIVER DR. STE. 165
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:85247
Practice Address - Country:US
Practice Address - Phone:214-631-5664
Practice Address - Fax:214-631-5665
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2011-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM5333207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine