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NPI Code Detail

MEDICARE: ZACHARY JAMES LONG MD

MEDICARE: ZACHARY JAMES 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
1207Q00000XFamily Medicine Physician036.156666IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2036156666OTHERILSTATE LICENSE

General Provider Information

NPI Number : 1669977104
Entity Type Code : Individual
Provider Name (Legal Business Name) : ZACHARY JAMES LONG MD
Provider Business Mailing Address
First Line : 3421 NORTHVIEW DR
Second Line :
City : JACKSON
State : MS
Zip : 39216-3112
Country : US
Telephone Number : 601-927-8822
Fax Number :
Provider Business Practice Location Address
First Line : 3245 N HALSTED ST
Second Line :
City : CHICAGO
State : IL
Zip : 60657-3419
Country : US
Telephone Number : 773-388-1600
Fax Number : 773-388-8936
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2018
Last Update Date : 06/26/2024

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Directions to “ ZACHARY JAMES LONG MD” Practice Location

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