Individual
DR. MICHAEL SCOTT LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4920 NE STALLINGS DR, NACOGDOCHES, TX 75965-1254
(972) 526-0340
(972) 996-1857
Mailing address
PO BOX 226, ROWLETT, TX 75030-0226
(972) 252-6034
(972) 996-1857
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
OS015429
PA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
QQ498
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
337951301
—
TX
05
—
337951302
—
TX
01
—
8EK438
BLUE CROSS BLUE SHIELD
TX
01
—
8EM612
BLUE CROSS BLUE SHIELD
TX
01
—
P01360899
RAILROAD MEDICARE
—
Enumeration date
09/11/2012
Last updated
12/22/2015
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