Provider Demographics
NPI:1639194384
Name:IAN PURCELL, MD, APC
Entity Type:Organization
Organization Name:IAN PURCELL, MD, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PURCELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-229-4941
Mailing Address - Street 1:6645 ALVARADO RD STE 415
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5208
Mailing Address - Country:US
Mailing Address - Phone:619-229-4941
Mailing Address - Fax:619-229-4950
Practice Address - Street 1:6645 ALVARADO RD STE 415
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5208
Practice Address - Country:US
Practice Address - Phone:619-229-4941
Practice Address - Fax:619-229-4950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA783222084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17335Medicare ID - Type Unspecified