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1104262781
TRAVIS DAVID LONG
DAYTONA BEACH, FL
NPI
1104262781
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: FL PA9107114)
Enumeration Date
2013-05-22
Last Update Date
2016-03-03
Business Address
-- TRAVIS DAVID LONG PA
303 N CLYDE MORRIS BLVD
DAYTONA BEACH, FL 32114-2709
Phone number: 386-254-4000
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Mailing Address
-- TRAVIS DAVID LONG PA
PO BOX 732901
DALLAS, TX 75373-2901
Phone number: 386-226-4590
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