Provider Demographics
NPI:1144551540
Name:DONALD P. LONG, M.D., P.A.
Entity type:Organization
Organization Name:DONALD P. LONG, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LONG
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:409-983-1066
Mailing Address - Street 1:4640 9TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-5820
Mailing Address - Country:US
Mailing Address - Phone:409-983-1066
Mailing Address - Fax:409-983-7272
Practice Address - Street 1:4640 9TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-5820
Practice Address - Country:US
Practice Address - Phone:409-983-1066
Practice Address - Fax:409-983-7272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097631801Medicaid
TX00BH09Medicare PIN
TXC18518Medicare UPIN