Provider Demographics
NPI:1972820355
Name:LONG, PAUL ROBERT (PAUL LONG MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ROBERT
Last Name:LONG
Suffix:
Gender:M
Credentials:PAUL LONG MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1550 NE 27TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7760
Mailing Address - Country:US
Mailing Address - Phone:541-313-8111
Mailing Address - Fax:541-313-8112
Practice Address - Street 1:1550 NE 27TH ST STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7760
Practice Address - Country:US
Practice Address - Phone:541-313-8111
Practice Address - Fax:541-313-8112
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK301992086S0129X
TXBP10037253390200000X
ORMD1966782086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program