Individual
THERESA MARIE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
JOHN A MORAN EYE CTR, 65 MARIO CAPECCHI DRIVE, SALT LAKE CITY, UT 84132-0001
(801) 213-4044
Mailing address
JOHN A MORAN EYE CTR, 65 MARIO CAPECCHI DRIVE, SALT LAKE CITY, UT 84132-0001
(801) 213-4044
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
10979080-1205
UT
Other
Enumeration date
04/03/2017
Last updated
11/18/2021
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