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Individual

DR. BENJAMIN DANIEL LONG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
800 E CARPENTER ST, SPRINGFIELD, IL 62769-4699
(217) 544-6464
Mailing address
111 OAKWOOD RD, EAST PEORIA, IL 61611-1853
(309) 740-4272

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
125.071892
IL
2085R0202X
Diagnostic Radiology Physician
313938
NC

Other

Enumeration date
06/02/2018
Last updated
08/14/2024
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