Provider Demographics
NPI:1760637284
Name:LONG, SCOTT WESLEY (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:WESLEY
Last Name:LONG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 FANNIN, M227
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-441-3490
Mailing Address - Fax:713-793-1603
Practice Address - Street 1:6565 FANNIN, M227
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-441-3490
Practice Address - Fax:713-793-1603
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8316207ZC0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology