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NPI Code Detail

MEDICARE: DR. LAWRENCE E LONG III MD

MEDICARE: DR. LAWRENCE E LONG III MD
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
1207R00000XInternal Medicine Physician4217AWY
2207R00000XInternal Medicine PhysicianMD27040OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396735346
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAWRENCE E LONG III MD
Provider Business Mailing Address
First Line : 1700 E 19TH ST
Second Line :
City : THE DALLES
State : OR
Zip : 97058-3317
Country : US
Telephone Number : 541-296-1111
Fax Number : 541-269-7601
Provider Business Practice Location Address
First Line : 1700 E 19TH ST
Second Line :
City : THE DALLES
State : OR
Zip : 97058-3317
Country : US
Telephone Number : 541-296-1111
Fax Number : 541-296-7601
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2005
Last Update Date : 12/06/2007

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Directions to “ DR. LAWRENCE E LONG III MD” Practice Location

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