Provider Demographics
NPI:1215923487
Name:LONG, WILLIAM M (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:M
Last Name:LONG
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3909 LAPALCO BLVD
Mailing Address - Street 2:STE. 100
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-2302
Mailing Address - Country:US
Mailing Address - Phone:504-349-6900
Mailing Address - Fax:504-340-4305
Practice Address - Street 1:3909 LAPALCO BLVD
Practice Address - Street 2:STE. 100
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-2302
Practice Address - Country:US
Practice Address - Phone:504-349-6900
Practice Address - Fax:504-340-4305
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2014-01-31
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Provider Licenses
StateLicense IDTaxonomies
LA012403207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1194115Medicaid
LA5L475Medicare ID - Type Unspecified
LA1194115Medicaid