Provider Demographics
NPI:1942006069
Name:LONG MEDICAL PLLC
Entity type:Organization
Organization Name:LONG MEDICAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:JON
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-914-3451
Mailing Address - Street 1:3614 KIESSEL RD
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32163-2910
Mailing Address - Country:US
Mailing Address - Phone:352-914-3451
Mailing Address - Fax:352-415-3952
Practice Address - Street 1:3614 KIESSEL RD
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-2910
Practice Address - Country:US
Practice Address - Phone:352-914-3451
Practice Address - Fax:352-415-3952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-20
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty