Provider Demographics
NPI:1659351260
Name:LONG, EDWIN THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:THOMAS
Last Name:LONG
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1 BOONE RD
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-1894
Mailing Address - Country:US
Mailing Address - Phone:360-475-4334
Mailing Address - Fax:360-475-4426
Practice Address - Street 1:1 BOONE RD
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-1894
Practice Address - Country:US
Practice Address - Phone:360-475-4334
Practice Address - Fax:360-475-4426
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
VA01010571302083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine