Provider Demographics
NPI:1598756702
Name:LONG, WILLIAM DENZIL SR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DENZIL
Last Name:LONG
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3335 PRESCOTT RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3916
Mailing Address - Country:US
Mailing Address - Phone:318-448-3210
Mailing Address - Fax:318-443-4874
Practice Address - Street 1:3335 PRESCOTT RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3916
Practice Address - Country:US
Practice Address - Phone:318-448-3210
Practice Address - Fax:318-443-4874
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAMD02813R207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B64534Medicare UPIN
53328B986Medicare ID - Type Unspecified