Provider Demographics
NPI:1760514293
Name:LONG, ROBERT P II (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:LONG
Suffix:II
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4656 CANOPY GROVE DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-7049
Mailing Address - Country:US
Mailing Address - Phone:216-904-6330
Mailing Address - Fax:
Practice Address - Street 1:250 N 1ST ST
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1702
Practice Address - Country:US
Practice Address - Phone:216-904-6330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR196807367500000X
CA95001599367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered