Provider Demographics
NPI:1689049702
Name:LONG, DOUGLAS WILLIAM (ACNPC-AG)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:WILLIAM
Last Name:LONG
Suffix:
Gender:M
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:403 W OAK ST STE 100
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4573
Mailing Address - Country:US
Mailing Address - Phone:870-875-1481
Mailing Address - Fax:870-875-1486
Practice Address - Street 1:403 W OAK ST STE 100
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4573
Practice Address - Country:US
Practice Address - Phone:870-875-1481
Practice Address - Fax:870-875-1485
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARA005415207RC0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease