| Mason H Long Md Pa | |
|
301 Health Park Blvd Ste 325 St Augustine FL 32086-5771 | |
| (904) 824-6164 | |
| (904) 824-0365 |
| Full Name | Mason H Long Md Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 301 Health Park Blvd Ste 325, St Augustine, Florida |
| Authorized Official Name and Position | Mason H Long (PRESIDENT/OWNER) |
| Authorized Official Contact | 9048246164 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mason H Long Md Pa 301 Health Park Blvd Ste 325 St Augustine FL 32086-5771 Ph: (904) 824-6164 | Mason H Long Md Pa 301 Health Park Blvd Ste 325 St Augustine FL 32086-5771 Ph: (904) 824-6164 |
| NPI Number | 1710204474 |
|---|---|
| Provider Enumeration Date | 04/21/2010 |
| Last Update Date | 04/21/2010 |
| Medicare PECOS PAC ID | 7719014844 |
|---|---|
| Medicare Enrollment ID | O20100422000205 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710204474 | NPI | - | NPPES |
| 038939100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Mason Long |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790854537 PECOS PAC ID: 0345377487 Enrollment ID: I20100422000258 |
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