Provider Demographics
NPI:1598494601
Name:LONG, BRE'ON (MD)
Entity Type:Individual
Prefix:
First Name:BRE'ON
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LEE'S SUMMIT FAMILY MEDICINE
Mailing Address - Street 2:600 NW MURRAY RD. SUITE 201
Mailing Address - City:LEE'S SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LEE'S SUMMIT FAMILY MEDICINE
Practice Address - Street 2:600 NW MURRAY RD. SUITE 201
Practice Address - City:LEE'S SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081
Practice Address - Country:US
Practice Address - Phone:913-222-9833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program