Long, Jackie
Long, Jackie is an individual health care provider with primary practice located at 407 3Rd St Se , Minot ND 58701-4470. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Long, Jackie can be contacted via phone (701) 857-2360.Contact Information
Primary practice address
407 3Rd St Se
Minot ND 58701-4470
Phone: (701) 857-2360
Fax: (701) 857-2187
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | ME126295 | Florida |
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | 16459 | North Dakota |
Profile Details
| NPI number | 1790039071 |
|---|---|
| LBN Legal business name | Long, Jackie |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 7th, 2012 |
| Last updated | Dec 28th, 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1790039071 | NPPES |
| Florida | Other | ME126295 | STATE LICENSE |
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