Individual
BENJAMIN C LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3105 MCCLELLAND BLVD., JOPLIN, MO 64804
(417) 347-5400
(417) 347-0620
Mailing address
3105 MCCLELLAND BLVD., JOPLIN, MO 64804
(417) 347-5400
(417) 347-0620
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2018002044
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
506033406
—
MO
Enumeration date
01/25/2018
Last updated
01/25/2018
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