Individual
MR. JAMES ELDON LONG SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
300A NW 1ST AVE, WILLISTON, FL 32696-2006
(352) 529-0966
(352) 529-0967
Mailing address
300A N,W, 1ST AVE, WILLISTON, FL 32696-6262
(352) 529-0966
(352) 529-0967
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA2538
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004428900
—
FL
01
—
Y09KU
BCBS
FL
Enumeration date
01/31/2007
Last updated
04/29/2014
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