Healthcare Provider Details

I. General information

NPI: 1922212729
Provider Name (Legal Business Name): JOSHUA WILLIAM LONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 MT PYRAMID CT STE 300
ENGLEWOOD CO
80112-2667
US

IV. Provider business mailing address

9695 S YOSEMITE ST STE 285
LONE TREE CO
80124-2890
US

V. Phone/Fax

Practice location:
  • Phone: 303-269-4370
  • Fax: 303-269-4371
Mailing address:
  • Phone: 303-269-4370
  • Fax: 303-269-4371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0051485
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number27181
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number51485
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: