MEDICARE: DR. LONG THAO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G66867	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245341445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LONG THAO M.D.

Provider Business Mailing Address
First Line	:	700 W OLIVE AVE
Second Line	:	SUITE A
City	:	MERCED
State	:	CA
Zip	:	95348-2435
Country	:	US
Telephone Number	:	209-384-8426
Fax Number	:	209-384-8015

Provider Business Practice Location Address
First Line	:	700 W OLIVE AVE
Second Line	:	SUITE A
City	:	MERCED
State	:	CA
Zip	:	95348-2435
Country	:	US
Telephone Number	:	209-384-8426
Fax Number	:	209-384-8015

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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