Provider Demographics
NPI:1710502794
Name:LONG, WILLIAM WESLEY JR (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WESLEY
Last Name:LONG
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 N REYNOLDS RD STE 170
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-2076
Mailing Address - Country:US
Mailing Address - Phone:419-578-4280
Mailing Address - Fax:
Practice Address - Street 1:2865 N REYNOLDS RD STE 170
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-2076
Practice Address - Country:US
Practice Address - Phone:419-578-4280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.016368207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine