Healthcare Provider Details

I. General information

NPI: 1194821868
Provider Name (Legal Business Name): JAMES MELVIN LONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 NUT TREE RD STE 390
VACAVILLE CA
95687-4100
US

IV. Provider business mailing address

1200 B GALE WILSON BLVD
FAIRFIELD CA
94533-3552
US

V. Phone/Fax

Practice location:
  • Phone: 707-624-8000
  • Fax: 707-624-8001
Mailing address:
  • Phone: 707-646-5611
  • Fax: 707-646-4902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberC50016
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: