Healthcare Provider Details

I. General information

NPI: 1467614008
Provider Name (Legal Business Name): RASMEY LONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MEDICAL PKWY BLDG B
CEDAR PARK TX
78613-7763
US

IV. Provider business mailing address

PO BOX 26726
AUSTIN TX
78755-0726
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-4083
  • Fax: 512-324-4717
Mailing address:
  • Phone: 512-407-8686
  • Fax: 512-406-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number70791
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP4342
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: