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Contact Information

STAFFORD R LONG, PA-C
2751 ALBERT L BICKNELL DR
SUITE 1-B
SHREVEPORT, LA71103-3920
 Phone: 318-212-8776
 Fax: 318-212-8774
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Surgical

363AS0400X 97 Physician Assistant
 

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for STAFFORD R LONG · (Male)

NPI Number 1851343396
Status Active
Credentials PA-C (Physician Assistant-Certified)
Entity Individual
Enumeration date 05/16/2006
Last updated 06/03/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • LA License # PA A10311
  • LA License # PA.A10311
  • LA Medicaid 1722928
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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