Individual
DR. KENNETH MICHAEL LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
5907 HIGHWAY 90, MOSS POINT, MS 39563-6536
(228) 769-2611
Mailing address
5907 HIGHWAY 90, MOSS POINT, MS 39563-6536
(504) 842-4000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22826
MS
207Q00000X
Family Medicine Physician
311654
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08224277
—
MS
01
—
P01332510
RAILROAD MEDICARE
MS
Enumeration date
06/17/2011
Last updated
01/26/2021
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