Individual
DR. MICHAEL THORNTON LONGAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD MBA
Contact information
Practice address
257 CAMPUS DR, STANFORD, CA 94305-5101
(650) 736-1707
(650) 736-1705
Mailing address
55 SHEARER DR, ATHERTON, CA 94027-3935
(650) 365-4838
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
G57362
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G573620
—
CA
Enumeration date
02/21/2007
Last updated
07/08/2007
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