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Organization
KENNETH L. LONG, M.D., P.A.
Active
Organization
KENNETH L. LONG, M.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH L LONG M.D. (PRESIDENT)
(512) 392-6081
Entity
Organization
Contact information
Practice address
1305 WONDER WORLD DR, SUITE 301, SAN MARCOS, TX 78666-7546
(512) 392-6081
(512) 353-7268
Mailing address
1305 WONDER WORLD DR, SUITE 301, SAN MARCOS, TX 78666-7546
(512) 392-6081
(512) 353-7268
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D8326
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114353902
—
TX
Enumeration date
02/20/2012
Last updated
02/20/2012
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