Individual
TIMOTHY R. LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1320 ANDREA ST, BOWLING GREEN, KY 42104-3334
(270) 746-5455
(270) 746-5688
Mailing address
5 CHESTNUT HILL CT, BOWLING GREEN, KY 42103-7002
(270) 746-5455
(270) 746-5688
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
33989
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000216368
ANTHEM BLUE CROSS & BLUE
—
01
—
35L1
ANTHEM BC/BS
KY
05
—
64339898
—
KY
Enumeration date
03/08/2006
Last updated
12/17/2009
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