Healthcare Provider Details

I. General information

NPI: 1801890686
Provider Name (Legal Business Name): HERBERT W LONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1054 CENTER DR STE 2
RICHMOND KY
40475-3851
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-625-5242
  • Fax: 859-625-5279
Mailing address:
  • Phone: 606-330-7835
  • Fax: 859-625-5279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31482
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: