Individual
RICHARD E LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
28256
WI
207R00000X
Internal Medicine Physician
44672
IA
207R00000X
Internal Medicine Physician
63014
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30826500
—
WI
Enumeration date
06/24/2005
Last updated
11/06/2017
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