Provider Demographics
NPI:1821099094
Name:LONG, RICHARD D (MD INC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:LONG
Suffix:
Gender:M
Credentials:MD INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N DIVISION ST
Mailing Address - Street 2:STE 100
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-3929
Mailing Address - Country:US
Mailing Address - Phone:775-883-1544
Mailing Address - Fax:775-883-1965
Practice Address - Street 1:1000 N DIVISION ST
Practice Address - Street 2:STE 100
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-3929
Practice Address - Country:US
Practice Address - Phone:775-883-1544
Practice Address - Fax:775-883-1965
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2007-10-09
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
NV2687207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2013261Medicaid
NV2013261Medicaid
NVV38683Medicare PIN