Individual
BRENTON VAUGHN LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
21159 PAINT BLVD, SUITE 2, SHIPPENVILLE, PA 16254-4023
(814) 226-6770
(814) 226-1015
Mailing address
121 DOCTORS LN, CLARION, PA 16214-8515
(814) 226-3470
(814) 226-3479
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
OS004611L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0008050560007
—
PA
Enumeration date
02/27/2006
Last updated
05/29/2008
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