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General NPI Number Information
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NPI Number | 1982966420
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Entity Type | Individual
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Provider Name | ANDREW MCCRAW LONG D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/11/2012
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 340 MAGNOLIA CIR
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City | PANAMA CITY
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State | FL
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Zip | 32403-5604
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Country | US
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Telephone | 850-283-7607
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Fax |
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Provider Business Mailing Address
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Address Line | 340 MAGNOLIA CIR BLDG 325TH
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City | PANAMA CITY
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State | FL
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Zip | 32403-5604
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Country | US
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Telephone | 850-283-7607
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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 | 2083A0100X
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Taxonomy Name | Aerospace Medicine Physician
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License Number | 1922
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License Number State | NE
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