Long, Jack E

Long, Jack E is an individual health care provider with primary practice located at 100 E 33Rd St Ste 100 , Vancouver WA 98663-2776. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Long, Jack E can be contacted via phone (360) 256-2000.

Contact Information

Primary practice address
100 E 33Rd St Ste 100 Vancouver WA 98663-2776
Phone: (360) 256-2000
Fax: (360) 514-7553
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X MD00028913 Washington
Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism 207RE0101X MD00028913 Washington

Profile Details

NPI number 1366480949
LBN Legal business name Long, Jack E
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 3rd, 2006
Last updated Feb 27th, 2008 - about 16 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 1366480949 NPPES
Washington MEDICAID 8131195

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