Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 18184 | NE |
NPI | 1003865429 |
---|---|
Provider Name | Douglas J Long |
First Address | Omaha, NE 68124 |
Second Address | Omaha, NE 68114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 13/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1967182 | (05) | IA |
47061940513 | (05) | NE |
95307 | BCBS (01) | IA |
95307 | BCBS (01) | NE |
E58821 | (02) | NE |