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Individual
RANDY J. LONG
Active
Individual
RANDY J. LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, FAPACUS
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15-00793
KS
363A00000X
Physician Assistant
1500793
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100402610B
—
KS
05
—
2004260304
—
KS
01
—
426953
BLUE CROSS BLUE SHIELD
KS
Enumeration date
11/02/2006
Last updated
01/28/2010
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