Individual
MR. KEITH EUGENE LONG
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
76 NE 12TH ST, MADRAS, OR 97741-1827
(541) 475-3874
(541) 475-3503
Mailing address
76 NE 12TH ST, MADRAS, OR 97741-1827
(541) 475-3874
(541) 475-3503
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00386
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150563
—
OR
Enumeration date
05/23/2006
Last updated
07/09/2007
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