Individual
JACK CALHOUN LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1900 SCENIC DR STE 1114, GEORGETOWN, TX 78626-7724
(512) 248-2200
(512) 248-1950
Mailing address
8240 N MOPAC EXPY STE 100, AUSTIN, TX 78759-8869
(512) 687-1950
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
D7435
TX
208800000X
Urology Physician
Primary
D7435
TX
Other
Enumeration date
11/02/2005
Last updated
11/01/2021
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