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General NPI Number Information
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NPI Number | 1801890686
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Entity Type | Individual
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Provider Name | HERBERT W LONG MD
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Gender | Male
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 08/07/2019
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Provider Practice Location Address
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Address Line | 417 RIVER DR
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City | IRVINE
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State | KY
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Zip | 40336-1272
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Country | US
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Telephone | 606-723-0399
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Fax | 606-723-0379
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Provider Business Mailing Address
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Address Line | PO BOX 936
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City | LONDON
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State | KY
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Zip | 40743-0936
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Country | US
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Telephone | 606-330-7818
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Fax | 606-330-7825
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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 | 31482
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License Number State | KY
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