Individual
JAY RICHARD LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1190 E MISSOURI AVE, SUIE 160, PHOENIX, AZ 85014-2734
(602) 246-7211
(602) 264-2462
Mailing address
116 W ROSE LN, PHOENIX, AZ 85013-1527
(602) 266-3997
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
8862
AZ
Other
Enumeration date
08/19/2006
Last updated
02/09/2010
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