Provider Demographics
NPI:1689049702
Name:LONG, DOUGLAS WILLIAM (ACNPC-AG)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:WILLIAM
Last Name:LONG
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Gender:M
Credentials:ACNPC-AG
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Mailing Address - Street 1:4301 W MARKHAM ST # 783
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-686-8000
Mailing Address - Fax:501-526-5148
Practice Address - Street 1:4301 W MARKHAM ST # 532
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-686-5311
Practice Address - Fax:501-686-6439
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2024-07-11
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Provider Licenses
StateLicense IDTaxonomies
ARA005415363LA2100X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease