Healthcare Provider Details

I. General information

NPI: 1528012820
Provider Name (Legal Business Name): MICHAEL J LONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11219 FINANCIAL CENTRE PKWY SUITE 215
LITTLE ROCK AR
72211-3800
US

IV. Provider business mailing address

11219 FINANCIAL CENTRE PKWY SUITE 215
LITTLE ROCK AR
72211-3800
US

V. Phone/Fax

Practice location:
  • Phone: 501-225-8346
  • Fax: 501-217-9819
Mailing address:
  • Phone: 501-225-8346
  • Fax: 501-217-9819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberE-2576
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: