Provider Demographics
NPI:1255435996
Name:LONG, JULIE A (MD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:LONG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:3377 S STATE ROAD 7
Practice Address - Street 2:SUITE 100
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8082
Practice Address - Country:US
Practice Address - Phone:561-341-7000
Practice Address - Fax:561-784-7098
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2022-02-01
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Provider Licenses
StateLicense IDTaxonomies
FLME627732086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055297600Medicaid
12863Medicare ID - Type Unspecified
FL055297600Medicaid