Individual
MR. JERRY LEE LONG JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6654 BITTEROOT LN, SAINT LOUIS, MO 63134-1451
(813) 494-1282
Mailing address
PO BOX 34086, SAINT LOUIS, MO 63134-0086
(813) 494-1282
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
08/12/2019
Last updated
08/12/2019
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