Individual
JEREMY A LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
777 BANNOCK ST, DENVER, CO 80204-4507
(303) 602-3499
(303) 602-3497
Mailing address
301 W 6TH AVE, MC 3251, DENVER, CO 80204-5182
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
42989
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42975042
—
CO
Enumeration date
08/07/2006
Last updated
06/20/2024
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