DR. MICHAEL DAVID LONG (NPI# 1386676542) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386676542 |
| Entity Type | Individual |
| Full Name | DR. MICHAEL DAVID LONG |
| Credential | M.D. |
| Practice Address |
3715 21st St Lubbock TX 79410-1219 |
| Mailing Address |
6102 82nd Street Ste 15 Lubbock TX 79424-3671 |
| Practice Telephone | 8067950610 |
| Practice Fax Number | 8067950602 |
| Mailing Telephone | 8067497933 |
| Mailing Fax Number | 8067496117 |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
J6551 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 046852201 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 6012 82nd St Ste 15, Lubbock, TX 794243671 | 8067497933 | 8067496117 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912416561 | Michael Paul Long | Social Worker | 14523 Westlake Drive, Lake Oswego, Or 97035, Lake Oswego, OR 97035 | 2017-09-27 |
| 1184096182 | Michael Keith Long | Registered Nurse | 606 N Kanawha St, Beckley, WV 25801-3819 | 2015-10-29 |
| 1679982110 | Michael Long | Pharmacist | 687 150th Ave, Monmouth, IL 61462-8719 | 2014-08-08 |
| 1457545097 | Michael Brandon Long | Counselor | 541 Veloce Trl, Fort Mill, SC 29715-7826 | 2007-08-28 |
| 1700905445 | Michael Ray Long | Acupuncturist | 1879 Portola Rd Ste L, Ventura, CA 93003-8095 | 2007-03-27 |
| 1538234745 | Michael Walter Long | Dentist | 78461 Highway 111, Plaza Dental Group, La Quinta, CA 92253-2076 | 2006-11-22 |
| 1205858578 | Michael Golden Long | Dentist | 7730 N Fresno St, Ste. 102, Fresno, CA 93720-2408 | 2006-07-24 |
| 1043239775 | Michael Arlin Long | Physician Assistant | 450 4th St., Dassel, MN 55325 | 2006-07-19 |
| 1053394700 | Michael Harrison Long | Physician Assistant | 870 Summit Crossing Pl, Gastonia, NC 28054 | 2005-11-28 |
| 1790336998 | Michael Thomas Long | Psychologist | 921 Chester Pike, Sharon Hill, PA 19079-1411 | 2019-09-27 |
| Street Address |
3715 21ST ST |
| City | LUBBOCK |
| State | TX |
| Zip Code | 79410-1219 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427087345 | Lehman Dermatology Clinic, P.a. | Dermatology | 3715 21st St, Lubbock, TX 79410-1219 | 2006-07-02 |
| 1174553556 | Bryan Harris | Dermatology | 3715 21st St, Lubbock, TX 79410-1219 | 2006-07-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548878267 | Covenant Medical Center | Clinic/Center | 3615 19th, Lifestyle Centre-east Parking Garage, Lubbock, TX 79410 | 2020-07-20 |
| 1669038626 | Hub City Anesthesia | Nurse Anesthetist, Certified Registered | 3416 22nd Street, Lubbock, TX 79410 | 2019-05-15 |
| 1912447418 | Lubbock Surgery Center, LLC | Clinic/Center | 3416 22nd St, Lubbock, TX 79410 | 2017-03-02 |
| 1871032698 | Lezlee Berry | Pharmacist | 3615 19th Street, Lubbock, TX 79410 | 2017-02-13 |
| 1376914101 | Matthew Cotton | Nurse Practitioner | 2424 Quaker Ave, Lubbock, TX 79410 | 2015-10-20 |
| 1841534864 | Frank Nwabugwu | Pharmacist | 4120 34th Street, Lubbock, TX 79410 | 2012-11-15 |
| 1689954794 | Dharmendra Kumar | Pediatrics | Covenant Children's Hospital, 4000 24th Street, Lubbock, TX 79410 | 2011-08-19 |
| 1518277177 | T.r.m. Rao, M.d., P.a. | Colon & Rectal Surgery | 3809 22nd Street, Suite C, Lubbock, TX 79410 | 2010-10-18 |
| 1700196672 | Hanford Consultations P.a. | Family Medicine | 4000 22nd Place Suite 100, Lubbock, TX 79410 | 2010-10-13 |
| 1336452598 | Amanda Collins | Specialist | 4801 34th Street, Lubbock, TX 79410 | 2010-07-16 |
| Find all providers in zip 79410 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679704530 | Paulger & Wisniewski Dermatology, LLP | Dermatology | 2202 Ithaca Ave, Lubbock, TX 79410-1332 | 2009-07-27 |
| 1194927368 | Ikue Shimizu | Dermatology | 3601 4th St, Ms 9400, Lubbock, TX 79430-0002 | 2007-06-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649800848 | Skin Cancer Dermatology, Pllc | Dermatology | 3327 Research Plz Ste 414, San Antonio, TX 78235-5159 | 2020-01-16 |
| 1598302721 | Austin Skin Pllc | Dermatology | 1501 Dorothy Nichols Ln # B, Smithville, TX 78957-1725 | 2019-12-06 |
| 1154717726 | Joshua Lee Owen | Dermatology | 2632 Broadway, Suite 300 South, San Antonio, TX 78215-7821 | 2015-04-10 |
| 1043615263 | Epiphany Dermatology Pa | Dermatology | 7106 Sanger Avenue, Waco, TX 76712-3928 | 2014-10-30 |
| 1255745915 | Leon Chen | Dermatology | 6655 Travis St Ste 650, Houston, TX 77030-1316 | 2014-06-19 |
| 1750624391 | Houston Skin Cancer Associates, Pllc | Dermatology | 1401 Binz Street, Suite 200, Houston, TX 77004 | 2013-04-02 |
| 1457695413 | Oliver Street 5.01(a) Inc. | Dermatology | 5310 Harvest Hill Rd Ste 290, Dallas, TX 75230-5826 | 2012-11-15 |
| 1427330588 | Michael A. Sorace Md Pa | Dermatology | 7950 Floyd Curl Dr Ste 505, Medical Center Tower 1, San Antonio, TX 78229-3924 | 2011-09-15 |
| 1811229180 | Skin Surgery Center, Pa | Dermatology | 6208 Colleyville Blvd, Suite 100, Colleyville, TX 76034-6223 | 2010-02-11 |
| 1265614168 | Michael Sorace | Dermatology | 745 W San Antonio Ave, Suite 100, Boerne, TX 78006-3213 | 2007-12-03 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.