Individual
DR. LAWRENCE E LONG III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1700 E 19TH ST, THE DALLES, OR 97058-3317
(541) 296-1111
(541) 296-7601
Mailing address
1700 E 19TH ST, THE DALLES, OR 97058-3317
(541) 296-1111
(541) 269-7601
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4217A
WY
207R00000X
Internal Medicine Physician
Primary
MD27040
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1067792
—
WA
05
—
247507
—
OR
Enumeration date
10/21/2005
Last updated
12/06/2007
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