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Individual

DR. ROBERT CRAIG LONG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D., PHARMD

Contact information

Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5601
Mailing address
2500 N STATE ST, DEPT OF INTERNAL MEDICINE/DIVISION OF CARDIOLOGY, JACKSON, MS 39216-4500
(601) 984-1000

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
E09167
MS
207R00000X
Internal Medicine Physician
19752
MS
207RA0001X
Advanced Heart Failure and Transplant Cardiology Physician
Primary
19752
MS
207RC0000X
Cardiovascular Disease Physician
19752
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00121925
MS
05
133721
AL
05
2406639
LA
01
P01330224
RAILROAD MEDICARE PTAN
MS
Enumeration date
05/09/2007
Last updated
06/06/2017
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