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General NPI Number Information
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NPI Number | 1699743567
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Entity Type | Individual
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Provider Name | TIMOTHY R. LONG M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 12/17/2009
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Provider Practice Location Address
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Address Line | 1320 ANDREA ST
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City | BOWLING GREEN
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State | KY
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Zip | 42104-3334
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Country | US
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Telephone | 270-746-5455
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Fax | 270-746-5688
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Provider Business Mailing Address
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Address Line | 5 CHESTNUT HILL CT
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City | BOWLING GREEN
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State | KY
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Zip | 42103-7002
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Country | US
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Telephone | 270-746-5455
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Fax | 270-746-5688
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 33989
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License Number State | KY
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