Individual
DENISE J LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1540 RANDOLPH AVE, SAINT PAUL, MN 55105-2535
(651) 699-8333
(651) 699-9257
Mailing address
2025 SLOAN PL STE 35, SAINT PAUL, MN 55117-2092
(651) 772-1572
(651) 772-1889
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
33578
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
957583900
—
MN
Enumeration date
08/11/2006
Last updated
10/17/2019
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