# DR. JOHN B LONG

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1881761948
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | G40974 | CA | Yes |

## Other

- **Enumeration date:** 11/30/2006
- **Last updated:** 07/18/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00G409741 | — | CA |
| 01 | — | 00G792860 | BLUE SHIELD | CA |
| 01 | — | P00080208 | RR MEDICARE | CA |