Provider Demographics
NPI:1861495384
Name:LONG, JOHN ALVA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALVA
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1000 19TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-4804
Mailing Address - Country:US
Mailing Address - Phone:205-930-0700
Mailing Address - Fax:205-930-9127
Practice Address - Street 1:1000 19TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4804
Practice Address - Country:US
Practice Address - Phone:205-930-0700
Practice Address - Fax:205-930-9127
Is Sole Proprietor?:No
Enumeration Date:2005-05-30
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14053207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000080153Medicaid
ALA29419Medicare UPIN
AL000080153Medicaid