Individual
DR. JACKIE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
407 3RD ST SE, MINOT, ND 58701-4470
(701) 857-2360
(701) 857-2187
Mailing address
PO BOX 5010, MINOT, ND 58702-5010
(701) 418-8000
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
16459
ND
2084P0800X
Psychiatry Physician
ME126295
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME126295
STATE LICENSE
FL
Enumeration date
11/07/2012
Last updated
04/30/2025
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