Provider Demographics
NPI:1982716478
Name:PAUL D. INDMAN, M.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PAUL D. INDMAN, M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:INDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-358-2788
Mailing Address - Street 1:15195 NATIONAL AVE
Mailing Address - Street 2:STE. 201
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2631
Mailing Address - Country:US
Mailing Address - Phone:408-358-2788
Mailing Address - Fax:
Practice Address - Street 1:15195 NATIONAL AVE
Practice Address - Street 2:STE. 201
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2631
Practice Address - Country:US
Practice Address - Phone:408-358-2788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29750174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA89486Medicare UPIN