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Individual
JUSTIN ALLEN LONG
Active
Individual
JUSTIN ALLEN LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
15-02009
KS
363AS0400X
Surgical Physician Assistant
Primary
1502009
KS
363AS0400X
Surgical Physician Assistant
PA150409
OR
Other
Enumeration date
11/03/2009
Last updated
03/04/2020
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