Individual
DR. TIMOTHY P LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 N HIGHWAY 47, MARTHASVILLE, MO 63357
(636) 433-5411
(636) 433-2910
Mailing address
901 PATIENTS FIRST DR, WASHINGTON, MO 63090-4700
(636) 239-4100
(636) 390-4341
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R9468
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010121863
RAILROAD MEDICARE
—
05
—
200987253
—
MO
Enumeration date
07/25/2006
Last updated
01/23/2012
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