Individual
MICHAEL THOMAS LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(208) 973-2144
Mailing address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
7771476
ID
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/20/2023
Last updated
10/27/2025
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