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General NPI Number Information
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NPI Number | 1386962439
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Entity Type | Organization
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Legal Business Name | DAVID A LONG MD, PA
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Dates
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Enumeration Date | 05/13/2010
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Last Update Date | 06/15/2011
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Provider Practice Location Address
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Address Line | 1615 PASADENA AVE S 250
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City | SOUTH PASADENA
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State | FL
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Zip | 33707-4516
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Country | US
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Telephone | 727-381-7727
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Fax | 727-381-8229
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Provider Business Mailing Address
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Address Line | 1615 PASADENA AVE S 250
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City | SOUTH PASADENA
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State | FL
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Zip | 33707-4516
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Country | US
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Telephone | 727-381-7727
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Fax | 727-381-8229
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID A LONG
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Credential | MD
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Telephone | 727-381-7727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME44760
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License Number State | FL
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