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General NPI Number Information
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NPI Number | 1588849871
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Entity Type | Individual
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Provider Name | SUZETTE MYTON LONG MD
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Gender | Female
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Dates
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Enumeration Date | 01/04/2008
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Last Update Date | 10/01/2009
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Provider Practice Location Address
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Address Line | 1997 MIAMISBURG-CENTERVILLE ROAD SOUTHVIEW HOSPITAL
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City | DAYTON
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State | OH
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Zip | 45459
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Country | US
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Telephone | 937-439-6000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 750353
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City | DAYTON
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State | OH
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Zip | 45475-0353
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Country | US
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Telephone | 937-439-1280
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 094166
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License Number State | OH
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