Individual
DR. GORDON DAVID LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
715 RICHLAND MALL, ONTARIO, OH 44906-3802
(419) 529-6195
Mailing address
700 N COLUMBUS ST, CRESTLINE, OH 44827-1455
(419) 529-6195
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35-04-9038L
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0537762
—
OH
Enumeration date
08/20/2006
Last updated
07/05/2022
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