Delong, Jack Wiley

Delong, Jack Wiley is an individual health care provider with primary practice located at 1900 Brother Geenen Way , Sarasota FL 34236-7102. He recently has only one registered license in Allopathic & Osteopathic Physicians / Otolaryngology, which is considered as his primary health care specialty. Delong, Jack Wiley can be contacted via phone (941) 556-3220.

Contact Information

Primary practice address
1900 Brother Geenen Way Sarasota FL 34236-7102
Phone: (941) 556-3220
Fax: (941) 955-8214
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Otolaryngology 207Y00000X 4301029955 Michigan

Profile Details

NPI number 1356349039
LBN Legal business name Delong, Jack Wiley
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 7th, 2005
Last updated Aug 14th, 2019 - 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 1356349039 NPPES
Michigan MEDICAID 102005454
Michigan Other P52387

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