Provider Demographics
NPI:1912910993
Name:LONG, JENNIFER BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:BETH
Last Name:LONG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3220 S DOUGLAS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-2734
Mailing Address - Country:US
Mailing Address - Phone:954-436-8444
Mailing Address - Fax:954-436-1159
Practice Address - Street 1:3220 S DOUGLAS RD
Practice Address - Street 2:SUITE B
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-2734
Practice Address - Country:US
Practice Address - Phone:954-436-8444
Practice Address - Fax:954-436-1159
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2010-05-19
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Provider Licenses
StateLicense IDTaxonomies
FLME93226208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275744300Medicaid