Organization
WILLIAM T LONG MD INC A CALIFORNIA PROFESSIONAL MEDICAL CORPORATION
Active
Organization
WILLIAM T LONG MD INC A CALIFORNIA PROFESSIONAL MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM T LONG MD (PHYSICIAN)
(323) 913-4300
Entity
Organization
Contact information
Practice address
1300 N VERMONT AVE STE 100, LOS ANGELES, CA 90027-6061
(323) 913-4300
Mailing address
1300 N VERMONT AVE STE 100, LOS ANGELES, CA 90027-6061
(323) 913-4300
Taxonomy
Speciality
Code
Description
License number
State
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
G060239
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G602390
—
CA
01
—
HI463A
MEDICARE PTAN
CA
Enumeration date
05/14/2013
Last updated
10/13/2020
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