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General NPI Number Information
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NPI Number | 1629177936
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Entity Type | Individual
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Provider Name | JEFFREY P. LONG MD
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Gender | Male
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 12/28/2011
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Provider Practice Location Address
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Address Line | 8166 MAIN ST STE 101
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City | HOUMA
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State | LA
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Zip | 70360-3404
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Country | US
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Telephone | 985-876-9045
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Fax |
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Provider Business Mailing Address
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Address Line | 4950 ESSEN LN
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City | BATON ROUGE
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State | LA
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Zip | 70809-3738
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Country | US
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Telephone | 225-215-1311
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | MD00038248
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 2085R0203X
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Taxonomy Name | Therapeutic Radiology Physician
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License Number | 202753
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License Number State | LA
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