Active NPI
Timothy Parker Long II
- Dentist
- Beaumont, TX
National Provider Identifier
1992111975
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 30056
- Practice address
- 6830 Phelan Blvd
Beaumont, TX 77706-5970 - Phone
- (409) 860-9600
- NPI assigned
- Jul 10, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 30056 | TX | Primary |
Addresses
Primary practice location
6830 Phelan Blvd
Beaumont, TX 77706-5970
Mailing address
1550 Katy Gap Rd
#3402
Katy, TX 77494-4353
Phone (281) 793-8735
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30056 | TX | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404950400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404950400000",
"number": "1992111975",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1550 KATY GAP RD",
"address_2": "#3402",
"city": "KATY",
"state": "TX",
"postal_code": "774944353",
"telephone_number": "281-793-8735"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6830 PHELAN BLVD",
"city": "BEAUMONT",
"state": "TX",
"postal_code": "777065970",
"telephone_number": "409-860-9600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONG",
"first_name": "TIMOTHY",
"middle_name": "PARKER",
"name_suffix": "II",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-07-10",
"last_updated": "2014-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "30056",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaumont, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.