Individual
DR. STEPHEN E LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3231 S NATIONAL AVE, SUITE 130, SPRINGFIELD, MO 65807-7304
(417) 888-5665
(417) 841-0108
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
Primary
R6H16
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
138827001
—
AR
05
—
1629117510
—
MO
01
—
173098
MO BLUE SHIELD
MO
01
—
431560263
TRICARE
MO
01
—
81453
ARK BLUE SHIELD
AR
Enumeration date
02/06/2007
Last updated
05/24/2013
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