Robert Wayne Long | St Charles, IL • PECOS Search

Robert Wayne Long

Family Medicine

Allopathic & Osteopathic Physicians

525 Tyler Rd, St Charles, IL 60174-3305

PECOS Enrollment

Based on the most recent information from CMS, provider Robert Wayne Long does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1083985154
Provider Type
Individual
Full Name
Long, Robert Wayne
Credential
D.O.

Gender
Male
Sole Proprietor
No
Enumeration Date
1/22/2012
Last Updated
1/22/2012

Contact Information

Practice Location

525 Tyler Rd, St Charles, IL 60174-3305

Unlisted Fax

Mailing Location

525 Tyler Rd, St Charles, IL 60174-3305

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License 036-075581 Illinois