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General NPI Number Information
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NPI Number | 1891929022
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Entity Type | Organization
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Legal Business Name | DEANNE LONG MD LLC
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Dates
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Enumeration Date | 05/01/2009
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Last Update Date | 05/01/2009
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Provider Practice Location Address
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Address Line | 2380 N 400 E
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City | LOGAN
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State | UT
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Zip | 84341-6000
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Country | US
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Telephone | 435-713-1354
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 571470
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City | SALT LAKE CITY
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State | UT
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Zip | 84157-1470
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Country | US
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Telephone | 310-388-9012
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Fax | 310-388-9013
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Authorized Official
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Title or Position | OWNER
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Name | MS. DEANNE LONG
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Credential | M.D.
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Telephone | 435-713-1350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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