Individual
JUSTIN ALLEN LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
501 S SANTA FE AVE, SUITE 200, SALINA, KS 67401
(785) 452-7562
(785) 452-7105
Mailing address
501 S SANTA FE AVE, SUITE 200, SALINA, KS 67401
(785) 452-7562
(785) 452-7105
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
15-02009
KS
363AS0400X
Surgical Physician Assistant
Primary
1502009
KS
363AS0400X
Surgical Physician Assistant
PA150409
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201166150A
—
KS
Enumeration date
11/03/2009
Last updated
03/04/2020
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