Provider Demographics
NPI:1487744900
Name:DR. DAVID D. LONG M.D., P.A.
Entity type:Organization
Organization Name:DR. DAVID D. LONG M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-714-4650
Mailing Address - Street 1:910 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-2928
Mailing Address - Country:US
Mailing Address - Phone:432-714-4650
Mailing Address - Fax:432-714-4653
Practice Address - Street 1:910 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-2928
Practice Address - Country:US
Practice Address - Phone:432-714-4650
Practice Address - Fax:432-714-4653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0574305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0059QPOtherBLUE CROSS BLUE SHIELD
TXDE4229OtherRAILROAD
TXC18512Medicare UPIN
TX0059QPOtherBLUE CROSS BLUE SHIELD