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NPI Code Detail

MEDICARE: DR. CLAYTON W LONG MD

MEDICARE: DR. CLAYTON W LONG 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
1390200000XStudent in an Organized Health Care Education/Training ProgramIA
2208000000XPediatrics Physician67305AZ
32080P0207XPediatric Hematology & Oncology Physician67305AZ

General Provider Information

NPI Number : 1568027647
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CLAYTON W LONG MD
Provider Business Mailing Address
First Line : 1919 E THOMAS RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-7710
Country : US
Telephone Number : 515-460-6232
Fax Number :
Provider Business Practice Location Address
First Line : 1919 E THOMAS RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-7710
Country : US
Telephone Number : 515-460-6232
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2019
Last Update Date : 04/30/2026

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