Individual
DR. THOMAS EUGENE LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1841 NUGGET DR, LAKE HAVASU CITY, AZ 86404-1813
(928) 453-8880
(928) 453-8880
Mailing address
PO BOX 5505, LAKE HAVASU CITY, AZ 86404-0201
(928) 453-8880
(928) 453-8880
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34402
AZ
Other
Enumeration date
11/19/2010
Last updated
11/19/2010
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