Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | E6480 | TX |
NPI | 1730175852 |
---|---|
Provider Name | Dr. William F. Long |
First Address | Austin, TX 78759 |
Second Address | Temple, TX 76502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 26/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
114479201 | (05) | TX |
C18512 | (02) |