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General NPI Number Information
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NPI Number | 1457311557
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Entity Type | Individual
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Provider Name | WILLIAM LAWRENCE LONG MD
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Gender | Male
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 02/18/2015
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Provider Practice Location Address
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Address Line | 100 MEDICAL CENTER DRIVE
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City | PRINCETON
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State | KY
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Zip | 42445-0410
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Country | US
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Telephone | 270-365-0442
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Fax | 270-365-6528
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Provider Business Mailing Address
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Address Line | PO BOX 42
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City | HOPKINSVILLE
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State | KY
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Zip | 42441-0042
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Country | US
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Telephone | 270-886-4556
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Fax | 270-707-9650
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number | 18271
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License Number State | KY
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