Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | R6H16 | MO |
NPI | 1629117510 |
---|---|
Provider Name | Dr. Stephen E Long |
First Address | Springfield, MO 65801-2580 |
Second Address | Springfield, MO 65807-7304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 24/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
138827001 | (05) | AR |
1629117510 | (05) | MO |
173098 | MO BLUE SHIELD (01) | MO |
431560263 | TRICARE (01) | MO |
81453 | ARK BLUE SHIELD (01) | AR |
A13139 | (02) |