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Brenton Vaughn Long, DO
General Practice Physician in Shippenville, Pennsylvania
NPI 1790751154

Brenton Vaughn Long is a General Practice Physician based in Clarion, PA. Brenton Vaughn Long practices in Shippenville, PA and has the professional credentials of DO. The NPI Number for Brenton Vaughn Long is 1790751154 and holds a License No. OS004611L (Pennsylvania).

The current practice location address for Brenton Vaughn Long is 21159 Paint Blvd, Shippenville, PA and can be reached out via phone at 814-226-6770 and via fax at 814-226-1015.

Location: 21159 Paint Blvd, Shippenville, PA, 16214-8515
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1790751154
Provider Name
Brenton Vaughn Long
Credential
DO
Provider Entity Type
Individual
Gender
Male
Address
21159 Paint Blvd, Shippenville, PA, 16214-8515
Phone Number
814-226-6770
Fax Number
814-226-1015
Provider Enumeration Date
02/27/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
0008050560007 05 PA
institution
Provider Business Practice Location Address Details
Address
21159 Paint Blvd
City
Shippenville
State
Pennsylvania
Zip
16254-4023
Phone Number
814-226-6770
Fax Number
814-226-1015
person
Provider Business Mailing Address Details
Address
21159 Paint Blvd
City
Shippenville
State
Pennsylvania
Zip
16254-4023
Phone Number
814-226-6770
Fax Number
814-226-1015
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
General Practice
Speciality
-
Taxonomy
208D00000X
License No.
OS004611L (Pennsylvania)
Definition
Definition to come...
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