Provider Demographics
NPI:1730175852
Name:LONG, WILLIAM F (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:F
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11770 JOLLYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759
Mailing Address - Country:US
Mailing Address - Phone:512-732-2774
Mailing Address - Fax:512-331-5192
Practice Address - Street 1:2027 S. 61ST ST
Practice Address - Street 2:#108
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502
Practice Address - Country:US
Practice Address - Phone:254-773-8916
Practice Address - Fax:254-228-5574
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6480207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114479201Medicaid
C18512Medicare UPIN
83G560Medicare ID - Type Unspecified