Provider Demographics
NPI:1689747776
Name:LONG, KEVIN BRANDON (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:BRANDON
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1124 COLUMBIA ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2026
Mailing Address - Country:US
Mailing Address - Phone:206-576-6050
Mailing Address - Fax:206-215-5935
Practice Address - Street 1:1124 COLUMBIA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2026
Practice Address - Country:US
Practice Address - Phone:206-576-6050
Practice Address - Fax:206-215-5935
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2016-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD60145491207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology