Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | ME62773 | FL |
NPI | 1255435996 |
---|---|
Provider Name | Julie A Long |
First Address | Miramar, FL 33025-3925 |
Second Address | Wellington, FL 33449-8082 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2006 |
Last Update Date | 01/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
055297600 | (05) | FL |