NPIMap

Organization Active NPI

Warren David. Long

  • Specialist
  • Shreveport, LA
National Provider Identifier
1689834400
Registry record updated Jun 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
02812R Issued in LA
Legal business name
WARREN DAVID. LONG
Practice address
2625 Line Ave
155
Shreveport, LA 71104-3047
Phone
(318) 424-8436
Fax
(318) 424-8438
NPI assigned
Jun 16, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2008

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

Authorized official

Name
Dr. Warren David Long Jr., MD
Title
MD/Owner
Phone
(318) 424-8436

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 02812R LA Primary

Addresses

Primary practice location

2625 Line Ave
155
Shreveport, LA 71104-3047

Mailing address

2625 Line Ave
155
Shreveport, LA 71104-3047
Phone (318) 424-8436

Other identifiers 1

IdentifierTypeStateIssuer
1107948MedicaidLA

National Provider Directory

National Provider Directory

Locations

2625 Line Ave
Ste 155
Shreveport, LA 71104
Phone (318) 424-8436

NPI Registry JSON

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

{
    "created_epoch": "1213574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213574400000",
    "number": "1689834400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2625 LINE AVE",
            "address_2": "155",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711043047",
            "telephone_number": "318-424-8436",
            "fax_number": "318-424-8438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2625 LINE AVE",
            "address_2": "155",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711043047",
            "telephone_number": "318-424-8436",
            "fax_number": "318-424-8438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WARREN DAVID. LONG",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-16",
        "last_updated": "2008-06-16",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "WARREN",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "318-424-8436",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "LA",
            "license": "02812R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1107948",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.