Healthcare Provider Details

I. General information

NPI: 1275625204
Provider Name (Legal Business Name): WILLIAM COOPER LONGTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 YGNACIO VALLEY RD
WALNUT CREEK CA
94598-3122
US

IV. Provider business mailing address

2250 MORELLO AVE
PLEASANT HILL CA
94523-1860
US

V. Phone/Fax

Practice location:
  • Phone: 925-939-3000
  • Fax:
Mailing address:
  • Phone: 925-287-1256
  • Fax: 925-287-0913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG71946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: