Individual
CHARLES LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1205 MARION AVE, TALLAHASSEE, FL 32303-6513
(850) 681-3887
(850) 681-0569
Mailing address
PO BOX 12427, TALLAHASSEE, FL 32317-2427
(850) 297-0114
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME26729
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
353116000
—
FL
Enumeration date
07/04/2006
Last updated
08/22/2013
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