Organization
WARREN DAVID. LONG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WARREN DAVID LONG JR. MD (MD/OWNER)
(318) 424-8436
Entity
Organization
Contact information
Practice address
2625 LINE AVE, 155, SHREVEPORT, LA 71104-3047
(318) 424-8436
(318) 424-8438
Mailing address
2625 LINE AVE, 155, SHREVEPORT, LA 71104-3047
(318) 424-8436
(318) 424-8438
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
02812R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1107948
—
LA
Enumeration date
06/16/2008
Last updated
06/16/2008
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