Long, Keith Eugene

Long, Keith Eugene is an individual health care provider with primary practice located at 76 Ne 12Th St , Madras OR 97741-1827. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Long, Keith Eugene can be contacted via phone (541) 475-3874.

Contact Information

Primary practice address
76 Ne 12Th St Madras OR 97741-1827
Phone: (541) 475-3874
Fax: (541) 475-3503
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA00386 Oregon

Profile Details

NPI number 1467407122
LBN Legal business name Long, Keith Eugene
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date May 23rd, 2006
Last updated Jul 9th, 2007 - about 18 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 1467407122 NPPES
Oregon MEDICAID 150563

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