MEDICARE: MOLLY U LONG PA-C

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	363A00000X	Physician Assistant	9847	AZ

General Provider Information

NPI Number	:	1285748673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY U LONG PA-C

Provider Business Mailing Address
First Line	:	7017 S PRIEST DR APT 3091
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-6048
Country	:	US
Telephone Number	:	314-596-8319
Fax Number	:

Provider Business Practice Location Address
First Line	:	1847 W HEATHERBRAE DR STE A
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-4764
Country	:	US
Telephone Number	:	602-274-2100
Fax Number	:	602-535-3166

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	03/15/2024

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