Provider Demographics
NPI:1841517604
Name:FUNNELL, IAN D (MD)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:D
Last Name:FUNNELL
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 1:9040 FITZSIMMONS DR
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-1000
Mailing Address - Country:US
Mailing Address - Phone:253-968-0375
Mailing Address - Fax:
Practice Address - Street 1:595 CHAPEL HILLS DR STE 240
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1056
Practice Address - Country:US
Practice Address - Phone:719-364-4120
Practice Address - Fax:719-364-4121
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101251785208D00000X
390200000X
CODR.0061123207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program