Individual
STAFFORD R LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2751 ALBERT L BICKNELL DR, SUITE 1-B, SHREVEPORT, LA 71103-3920
(318) 212-8776
(318) 212-8774
Mailing address
2751 ALBERT L BICKNELL DR, SUITE 1-B, SHREVEPORT, LA 71103-3920
(318) 212-8776
(318) 212-8774
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA.A10311
LA
363AS0400X
Surgical Physician Assistant
Primary
PA A10311
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1722928
—
LA
Enumeration date
05/16/2006
Last updated
06/03/2021
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