Provider Demographics
NPI:1396442182
Name:MICHAEL DAVID LONG MD PA
Entity type:Organization
Organization Name:MICHAEL DAVID LONG MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-787-9111
Mailing Address - Street 1:3223 S LOOP 289 STE 325
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1351
Mailing Address - Country:US
Mailing Address - Phone:806-412-5224
Mailing Address - Fax:806-412-5221
Practice Address - Street 1:3223 S LOOP 289 STE 325
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1351
Practice Address - Country:US
Practice Address - Phone:806-412-5224
Practice Address - Fax:806-412-5224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty