Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | DR.0060861 | CO |
Y | 207SG0201X | Clinical Genetics (M.D.) | DR.0060861 | CO |
NPI | 1740676683 |
---|---|
Provider Name | Patrick Long |
First Address | Denver, CO 80218-1291 |
Second Address | Denver, CO 80218-1291 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2015 |
Last Update Date | 02/12/2021 |