Provider Demographics
NPI:1578669404
Name:LONG, DANIEL ARTHUR (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ARTHUR
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:120 MEADOWCREST ST
Mailing Address - Street 2:#330
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056
Mailing Address - Country:US
Mailing Address - Phone:504-391-7560
Mailing Address - Fax:504-394-2269
Practice Address - Street 1:120 MEADOWCREST ST
Practice Address - Street 2:#330
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056
Practice Address - Country:US
Practice Address - Phone:504-391-7560
Practice Address - Fax:504-394-2269
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA013818207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1199273Medicaid
1361269Medicare UPIN
LA1199273Medicaid