Provider Demographics
NPI:1780953380
Name:LONG, ROBERT (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:LONG
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5483
Mailing Address - Street 2:
Mailing Address - City:RAS TANURA
Mailing Address - State:EASTERN PROVINCE
Mailing Address - Zip Code:31311
Mailing Address - Country:SA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6016 DRIFTWOOD AVE
Practice Address - Street 2:
Practice Address - City:RAS TANURA
Practice Address - State:EASTERN PROVINCE
Practice Address - Zip Code:31311
Practice Address - Country:SA
Practice Address - Phone:9663-677-4702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100406207PE0005X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine