Provider Demographics
NPI:1063711075
Name:LONG, JASON (RPA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:LONG
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 ANDREWS ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-7073
Mailing Address - Country:US
Mailing Address - Phone:970-377-2605
Mailing Address - Fax:
Practice Address - Street 1:2139 ANDREWS ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-7073
Practice Address - Country:US
Practice Address - Phone:970-377-2605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant