Provider Demographics
NPI:1023423555
Name:LONG, CALEB BERT (DO)
Entity type:Individual
Prefix:DR
First Name:CALEB
Middle Name:BERT
Last Name:LONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 HOLLY SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-8307
Mailing Address - Country:US
Mailing Address - Phone:304-687-4039
Mailing Address - Fax:321-433-2311
Practice Address - Street 1:250 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8625
Practice Address - Country:US
Practice Address - Phone:321-338-1618
Practice Address - Fax:321-433-2311
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14699207R00000X
VA0116027421207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine