Provider Demographics
NPI:1447449442
Name:RICHARD D LONG MD INC
Entity type:Organization
Organization Name:RICHARD D LONG MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD INC
Authorized Official - Phone:775-883-1544
Mailing Address - Street 1:1000 N DIVISION ST
Mailing Address - Street 2:STE 100
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-3928
Mailing Address - Country:US
Mailing Address - Phone:775-883-1544
Mailing Address - Fax:775-883-1965
Practice Address - Street 1:1000 N DIVISION ST
Practice Address - Street 2:STE 100
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-3929
Practice Address - Country:US
Practice Address - Phone:775-883-1544
Practice Address - Fax:775-883-1965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVC96281Medicare UPIN
NVV38683Medicare PIN