Individual
DANIEL LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1203 S TYLER ST, COVINGTON, LA 70433-2353
(985) 898-7175
(985) 898-7178
Mailing address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-4000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
303108
LA
363AS0400X
Surgical Physician Assistant
Primary
303108
LA
363AS0400X
Surgical Physician Assistant
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA.303108
STATE LICENSE
LA
Enumeration date
04/28/2016
Last updated
05/16/2025
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