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Individual
DR. JOHN B LONG
Active
Individual
DR. JOHN B LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
G40974
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G409741
—
CA
01
—
00G792860
BLUE SHIELD
CA
01
—
P00080208
RR MEDICARE
CA
Enumeration date
11/30/2006
Last updated
07/18/2017
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