Healthcare Provider Details

I. General information

NPI: 1457457764
Provider Name (Legal Business Name): WILLIAM STEVEN LONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 11/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 N RIVERSIDE RD SUITE G 50
SAINT JOSEPH MO
64507-2553
US

IV. Provider business mailing address

802 N RIVERSIDE RD SUITE G 50
SAINT JOSEPH MO
64507-2553
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-6666
  • Fax: 816-271-1300
Mailing address:
  • Phone: 816-671-4888
  • Fax: 816-671-4890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR5N29
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: