Healthcare Provider Details

I. General information

NPI: 1043368723
Provider Name (Legal Business Name): WILLIAM PAUL LONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 WHITNEY AVE BUILDING 3
GRETNA LA
70056-5011
US

IV. Provider business mailing address

300 AUDUBON ST
NEW ORLEANS LA
70118-4906
US

V. Phone/Fax

Practice location:
  • Phone: 504-361-3757
  • Fax: 504-361-3132
Mailing address:
  • Phone: 504-864-2039
  • Fax: 504-361-3132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number023755
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number023755
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: