Provider Demographics
NPI:1891960647
Name:JAMES PHILLIP LONG DPM PA
Entity type:Organization
Organization Name:JAMES PHILLIP LONG DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:727-736-6741
Mailing Address - Street 1:210 PATRICIA AVE
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-8124
Mailing Address - Country:US
Mailing Address - Phone:727-736-6741
Mailing Address - Fax:727-733-6965
Practice Address - Street 1:210 PATRICIA AVE
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-8124
Practice Address - Country:US
Practice Address - Phone:727-736-6741
Practice Address - Fax:727-733-6965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 601213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041218000Medicaid
FL87234Medicare PIN
FL4431820001Medicare NSC
FL041218000Medicaid
FLT55381Medicare UPIN