Organization · NPI-2

Jonathan Ray Long MD LLC

Family Medicine · Weatherford, OK

NPI number1225349244
StatusActive
Last updated in NPPESFeb 25, 2019

Details

NPI
1225349244
Entity type
Organization (NPI-2)
Legal business name
Jonathan Ray Long MD LLC
Organization subpart
No
Enumeration date
Jun 24, 2010
Last updated
Feb 25, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine––Yes

Practice location

210 E Franklin Ave
Weatherford, OK 73096-5135

Phone 580-772-5600 · Fax 580-772-5604

Mailing address

3735 Legacy Drive
Weatherford, OK 73096-3309

Phone 580-772-5600 · Fax 580-772-5604

Authorized official

Jonathon Ray Long
President
5807725600

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