Healthcare Provider Details

I. General information

NPI: 1295302891
Provider Name (Legal Business Name): LANDON WHITTINGTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 BUHNE ST STE A
EUREKA CA
95501-3205
US

IV. Provider business mailing address

2350 BUHNE ST STE A
EUREKA CA
95501-3205
US

V. Phone/Fax

Practice location:
  • Phone: 707-443-4593
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number185671
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: