Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | OP00001806 | WA |
NPI | 1033149125 |
---|---|
Provider Name | Dr. John F Long |
First Address | Spokane, WA 99207-1214 |
Second Address | Spokane, WA 99207-1214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 15/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033149125 | (05) | WA |
P01422693 | RR MEDICARE (01) | WA |