Provider Demographics
NPI:1760899777
Name:DO, LONG (MD)
Entity Type:Individual
Prefix:
First Name:LONG
Middle Name:
Last Name:DO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32399-6548
Mailing Address - Country:US
Mailing Address - Phone:850-717-3269
Mailing Address - Fax:850-921-9757
Practice Address - Street 1:501 S CALHOUN ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32399-6548
Practice Address - Country:US
Practice Address - Phone:850-717-3269
Practice Address - Fax:850-921-9757
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47732208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice