Healthcare Provider Details

I. General information

NPI: 1457311557
Provider Name (Legal Business Name): WILLIAM LAWRENCE LONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL CENTER DRIVE
PRINCETON KY
42445-0410
US

IV. Provider business mailing address

PO BOX 42
HOPKINSVILLE KY
42441-0042
US

V. Phone/Fax

Practice location:
  • Phone: 270-365-0442
  • Fax: 270-365-6528
Mailing address:
  • Phone: 270-886-4556
  • Fax: 270-707-9650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number18271
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: