Individual
DR. MICHAEL DAVID LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6012 82ND ST STE 15, LUBBOCK, TX 79424-3671
(806) 749-7933
(806) 749-6117
Mailing address
6610 NORWOOD AVE, LUBBOCK, TX 79413-5909
(806) 787-9111
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
J6551
TX
207ND0101X
MOHS-Micrographic Surgery Physician
J6551
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046852201
—
TX
Enumeration date
07/07/2006
Last updated
05/17/2023
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