Individual
JEFFREY A LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1821 S WEBSTER AVE, GREEN BAY, WI 54301-2253
(920) 496-4700
Mailing address
1824 TROTTER CT, DE PERE, WI 54115-4013
(910) 823-7961
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4603
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100085562
—
WI
Enumeration date
12/06/2018
Last updated
05/12/2022
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