Provider Demographics
NPI:1477894889
Name:FLANIGAN, GEORGE III (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:FLANIGAN
Suffix:III
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 1:1510 W VERDUGO AVE STE F
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2473
Mailing Address - Country:US
Mailing Address - Phone:818-861-7755
Mailing Address - Fax:
Practice Address - Street 1:1510 W VERDUGO AVE STE F
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2473
Practice Address - Country:US
Practice Address - Phone:818-861-7755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47749207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA47749OtherCAL MED LIC