Long, Gordon David
Long, Gordon David is an individual health care provider with primary practice located at 715 Richland Mall , Ontario OH 44906-3802. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Long, Gordon David can be contacted via phone (419) 529-6195.Contact Information
Primary practice address
715 Richland Mall
Ontario OH 44906-3802
Phone: (419) 529-6195
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 35-04-9038L | Ohio |
Profile Details
| NPI number | 1487769766 |
|---|---|
| LBN Legal business name | Long, Gordon David |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 20th, 2006 |
| Last updated | Jul 5th, 2022 - about 4 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1487769766 | NPPES |
| Ohio | MEDICAID | 0537762 |
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