Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PO00000225 | WA |
Y | 222Z00000X | Podiatrist | PO00000225 | WA |
NPI | 1033191408 |
---|---|
Provider Name | Dr. Curtis W Long |
First Address | Walla Walla, WA 99362-3054 |
Second Address | Walla Walla, WA 99362-3054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 01/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T03110 | (02) | WA |