Individual
DR. MITCHELL D LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1512 12TH AVE RD, NAMPA, ID 83686-6008
(208) 463-5100
Mailing address
2463 EASTDALE DR, BOISE, ID 83712-6724
(208) 343-2587
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0-273
ID
Other
Enumeration date
07/25/2006
Last updated
07/08/2007
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