Long, Stafford R

Long, Stafford R is an individual health care provider with primary practice located at 2751 Albert L Bicknell Dr Suite 1-B, Shreveport LA 71103-3920. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Surgical is his primary health care specialty. Long, Stafford R can be contacted via phone (318) 212-8776.

Contact Information

Primary practice address
2751 Albert L Bicknell Dr Suite 1-B Shreveport LA 71103-3920
Phone: (318) 212-8776
Fax: (318) 212-8774
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA.A10311 Louisiana
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA A10311 Louisiana

Profile Details

NPI number 1851343396
LBN Legal business name Long, Stafford R
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date May 16th, 2006
Last updated Jun 3rd, 2021 - about 5 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 1851343396 NPPES
Louisiana MEDICAID 1722928

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