Healthcare Provider Details

I. General information

NPI: 1922175322
Provider Name (Legal Business Name): CECIL LONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 INDEPENDENCE PLZ STE 810
BIRMINGHAM AL
35209-2647
US

IV. Provider business mailing address

1 INDEPENDENCE PLZ STE 810
BIRMINGHAM AL
35209-2647
US

V. Phone/Fax

Practice location:
  • Phone: 205-307-0484
  • Fax: 205-278-1447
Mailing address:
  • Phone: 205-307-0484
  • Fax: 205-278-1447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number19244
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: