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General NPI Number Information
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NPI Number | 1972688521
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Entity Type | Individual
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Provider Name | ERIC WILLIAM LONG MD
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 01/07/2014
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Provider Practice Location Address
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Address Line | 1323 SW SCHAEFFER RD
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City | WEST LINN
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State | OR
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Zip | 97068-9658
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Country | US
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Telephone | 503-638-1717
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Fax | 503-692-1992
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Provider Business Mailing Address
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Address Line | 1323 SW SCHAEFFER RD
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City | WEST LINN
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State | OR
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Zip | 97068-9658
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Country | US
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Telephone | 503-638-1717
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Fax | 503-692-1992
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 10871
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License Number State | OR
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