Long, Dylan Jasper

Long, Dylan Jasper is an individual health care provider with primary practice located at 5165 Mccarty Ln , Lafayette IN 47905-8764. He recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Emergency Medicine. Allopathic & Osteopathic Physicians / Emergency Medicine is his primary health care specialty. Long, Dylan Jasper can be contacted via phone (765) 448-8000.

Contact Information

Primary practice address
5165 Mccarty Ln Lafayette IN 47905-8764
Phone: (765) 448-8000
Fax: (317) 838-4751
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 01089946A Indiana

Profile Details

NPI number 1043848120
LBN Legal business name Long, Dylan Jasper
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 1st, 2020
Last updated Aug 2nd, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1043848120 NPPES
Indiana Other 264430H21 MEDICARE PTAN
Indiana MEDICAID 300074582 MEDICARE PTAN

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