Individual
DOUGLAS M. LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
N19W23993 RIDGEVIEW PKWY W STE 100, WAUKESHA, WI 53188-1031
(262) 547-3352
Mailing address
N19W23993 RIDGEVIEW PKWY W STE 100, WAUKESHA, WI 53188-1031
(262) 547-3352
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
39703
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32443200
—
WI
01
—
P00449642
RR MEDICARE
WI
Enumeration date
06/26/2006
Last updated
12/26/2023
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