MEDICARE: JAMES MELVIN LONG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	C50016	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C50016	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1194821868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES MELVIN LONG M.D.

Provider Business Mailing Address
First Line	:	1200 B GALE WILSON BLVD
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-3552
Country	:	US
Telephone Number	:	707-646-5611
Fax Number	:	707-646-4902

Provider Business Practice Location Address
First Line	:	1020 NUT TREE RD STE 390
Second Line	:
City	:	VACAVILLE
State	:	CA
Zip	:	95687-4100
Country	:	US
Telephone Number	:	707-624-8000
Fax Number	:	707-624-8001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	12/21/2023

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