Provider Demographics
NPI:1801865142
Name:LONG, CHAD J (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:J
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 10597
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78766-1597
Mailing Address - Country:US
Mailing Address - Phone:512-420-0186
Mailing Address - Fax:512-420-0397
Practice Address - Street 1:7200 WYOMING SPGS
Practice Address - Street 2:SUITE 1300
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4303
Practice Address - Country:US
Practice Address - Phone:512-244-2273
Practice Address - Fax:512-244-3179
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2017-02-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA85418207R00000X
TXM6265207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J8085Medicare PIN