Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | G60239 | CA |
NPI | 1023067055 |
---|---|
Provider Name | Dr. William T Long |
First Address | Los Angeles, CA 90027-6061 |
Second Address | Los Angeles, CA 90027-6061 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 11/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G602390 | (05) | CA |
F32540 | (02) | CA |