Michael David Long MD PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

MICHAEL DAVID LONG MD PA

Practice address

3223 S Loop 289 Ste 325
Lubbock, TX 79423-1351

Phone

(806) 412-5224

Fax

(806) 412-5224

NPI assigned

Feb 13, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael David Long, MDNPI 1386676542

Title

Owner/MD

Phone

(806) 787-9111

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael David Long, M.D.

  • Dermatology Physician
  • Lubbock, TX
  • NPI 1386676542
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1676246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676246400000",
    "number": "1396442182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3223 S LOOP 289 STE 325",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794231351",
            "telephone_number": "806-412-5224",
            "fax_number": "806-412-5221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3223 S LOOP 289 STE 325",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794231351",
            "telephone_number": "806-412-5224",
            "fax_number": "806-412-5224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL DAVID LONG MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-13",
        "last_updated": "2023-02-13",
        "certification_date": "2023-02-11",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER/MD",
        "authorized_official_telephone_number": "806-787-9111",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Lubbock, TX
• Providers in Lubbock, TX by specialty
• Dermatology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.