Doctor Name: | STEPHEN GENE LONG |
NPI Number: | 1073598207 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | P.A. |
License Number: | 1033659 NCCPA |
Business Practice Address: | 4881 Sugar Maple Drive Wpafb Medical Center Wpafb, OH - 45324 |
Business Phone Number: | 9372573509 |
Business Fax Number: | 9372573509 |
Mailing Address: | 4881 Sugar Maple Drive, Wpafb Medical Center WPAFB |
State: | OH |
Postal Code: | 45324 |
Phone Number: | 9372573509 |
Fax Number: | 9372573509 |
NPI Enumeration Date: | 12/09/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | 1033659 NCCPA |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |