Individual
DR. JACK WILEY DELONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1900 BROTHER GEENEN WAY, SARASOTA, FL 34236-7102
(941) 556-3220
(941) 955-8214
Mailing address
111 W 24TH ST, HOLLAND, MI 49423-4791
(616) 396-2325
(616) 396-0317
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
4301029955
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102005454
—
MI
01
—
P52387
BCN MICHIGAN
MI
Enumeration date
07/07/2005
Last updated
08/14/2019
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