Provider Demographics
NPI:1255791166
Name:DELONG, ROBERT JAMES
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:DELONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 HOLCOMB BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3903
Mailing Address - Country:US
Mailing Address - Phone:228-872-6821
Mailing Address - Fax:228-872-6891
Practice Address - Street 1:900 HOLCOMB BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3903
Practice Address - Country:US
Practice Address - Phone:228-872-6821
Practice Address - Fax:228-872-6891
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT06472255A2300X
AL10412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer