Provider Demographics
NPI:1043368723
Name:LONG, WILLIAM PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PAUL
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:300 AUDUBON ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-4906
Mailing Address - Country:US
Mailing Address - Phone:504-864-2039
Mailing Address - Fax:504-361-3132
Practice Address - Street 1:1141 WHITNEY AVE
Practice Address - Street 2:BUILDING 3
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-5011
Practice Address - Country:US
Practice Address - Phone:504-361-3757
Practice Address - Fax:504-361-3132
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023755207ZD0900X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1488437Medicaid
MS04930021Medicaid
LAH82850Medicare UPIN
LA4F0987061Medicare PIN
LA1488437Medicaid