1851728539 NPI number — DR. IAN GORDON FLEETWOOD MD, BSC, BSC(MED)

Table of content: DR. IAN GORDON FLEETWOOD MD, BSC, BSC(MED) (NPI 1851728539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851728539 NPI number — DR. IAN GORDON FLEETWOOD MD, BSC, BSC(MED)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLEETWOOD
Provider First Name:
IAN
Provider Middle Name:
GORDON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, BSC, BSC(MED)
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851728539
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
605 DISCOVERY STREET
Provider Second Line Business Mailing Address:
CBI HEALTH CENTRE - 2ND FLOOR
Provider Business Mailing Address City Name:
VICTORIA
Provider Business Mailing Address State Name:
BRITISH COLUMBIA (BC)
Provider Business Mailing Address Postal Code:
V8T 5G4
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
12503833638
Provider Business Mailing Address Fax Number:
12503833638

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
605 DISCOVERY STREET
Provider Second Line Business Practice Location Address:
CBI HEALTH CENTRE - 2ND FLOOR
Provider Business Practice Location Address City Name:
VICTORIA
Provider Business Practice Location Address State Name:
BRITISH COLUMBIA (BC)
Provider Business Practice Location Address Postal Code:
V8T 5G4
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
12503833638
Provider Business Practice Location Address Fax Number:
12503833638
Provider Enumeration Date:
09/26/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  A72284 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com