Individual
ROBERT LAWRENCE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
909 MAR WALT DR, SUITE 1011, FORT WALTON BEACH, FL 32547-6635
(850) 863-3377
Mailing address
2234 COLONIAL BLVD, MANAGED CARE DEPT, FORT MYERS, FL 33907-1412
(239) 931-7342
(239) 931-7385
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
ME0043999
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1193377
WELLCARE
FL
01
—
382563
AVMED
FL
01
—
47173
BCBS OF FL
FL
01
—
P00728665
RR MEDICARE
FL
Enumeration date
02/23/2006
Last updated
12/08/2016
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