Healthcare Provider Details

I. General information

NPI: 1740676683
Provider Name (Legal Business Name): PATRICK LONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 19TH AVE STE 6450
DENVER CO
80218-1291
US

IV. Provider business mailing address

1601 E 19TH AVE STE 6450
DENVER CO
80218-1291
US

V. Phone/Fax

Practice location:
  • Phone: 303-832-7109
  • Fax: 440-294-4079
Mailing address:
  • Phone: 212-203-1309
  • Fax: 440-294-4079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0060861
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207SG0202X
TaxonomyClinical Biochemical Genetics Physician
License NumberDR.0060861
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberDR.0060861
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: