Individual
DR. JACK E LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 E 33RD ST STE 100, VANCOUVER, WA 98663-2776
(360) 256-2000
(360) 514-7553
Mailing address
PO BOX 1600, VANCOUVER, WA 98668-1600
(360) 514-7550
(360) 514-7553
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00028913
WA
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
MD00028913
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8131195
—
WA
Enumeration date
06/03/2006
Last updated
02/27/2008
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