Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A121255 | CA |
NPI | 1003106212 |
---|---|
Provider Name | Dr. Ian J Nelligan |
First Address | Palo Alto, CA 94304-1416 |
Second Address | Palo Alto, CA 94304-1416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2011 |
Last Update Date | 17/09/2013 |