Basic Information
| Provider Information | |||||||||
| NPI: | 1730389073 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RONALD J. LONG, MD. LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 PLAZA CIR | ||||||||
| Address2: | SUITE J | ||||||||
| City: | CLINTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293257559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648333400 | ||||||||
| FaxNumber: | 8648339039 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 PLAZA CIR | ||||||||
| Address2: | SUITE J | ||||||||
| City: | CLINTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293257559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648333400 | ||||||||
| FaxNumber: | 8648339039 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2007 | ||||||||
| LastUpdateDate: | 10/11/2007 | ||||||||
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| AuthorizedOfficialLastName: | LONG | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8648333400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.