Individual
ADAM W LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1-105356
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117007
—
AL
01
—
1891027199
TRICARE
AL
01
—
511-02950
BC BS OF AL
—
Enumeration date
02/11/2010
Last updated
04/05/2010
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