Individual
SAMUEL EVERETTE LONG III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3816 S 1ST ST, AUSTIN, TX 78704-7048
(512) 443-1311
Mailing address
6210 E HWY 290 STE 420, AUSTIN, TX 78723-1142
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
Q9853
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
402015801
—
TX
05
—
402015802
—
TX
Enumeration date
05/30/2013
Last updated
11/06/2019
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