Individual
JOSEPH MICHAEL LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7000 JEFFERSON ST NE, ALBUQUERQUE, NM 87109-4313
(505) 344-9478
(505) 344-2783
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01033377A
IN
208100000X
Physical Medicine & Rehabilitation Physician
Primary
IN01033377
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000795486
BCBS BMG ORTHOPEDIC TRAUMA
IN
01
—
000000897901
BCBS BMG IRELAND RD
IN
05
—
100223880
—
IN
05
—
100223880A
—
IN
01
—
P01173108
RR MEDICARE
IN
Enumeration date
10/19/2006
Last updated
03/31/2018
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