Provider Demographics
NPI:1720057557
Name:LANDAKER, STEPHEN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DAVID
Last Name:LANDAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 RALEY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-8347
Mailing Address - Country:US
Mailing Address - Phone:530-897-4500
Mailing Address - Fax:530-897-4544
Practice Address - Street 1:131 RALEY BLVD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-8347
Practice Address - Country:US
Practice Address - Phone:530-897-4500
Practice Address - Fax:530-897-4544
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41126207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ52846ZOtherBLUE SHIELD
CA00G411260Medicaid
ZZZ13431ZMedicare ID - Type Unspecified
E29222Medicare UPIN