Healthcare Provider Details

I. General information

NPI: 1851728539
Provider Name (Legal Business Name): IAN GORDON FLEETWOOD MD, BSC, BSC(MED)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2013
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 DISCOVERY STREET CBI HEALTH CENTRE - 2ND FLOOR
VICTORIA BRITISH COLUMBIA (BC)
V8T 5G4
CA

IV. Provider business mailing address

605 DISCOVERY STREET CBI HEALTH CENTRE - 2ND FLOOR
VICTORIA BRITISH COLUMBIA (BC)
V8T 5G4
CA

V. Phone/Fax

Practice location:
  • Phone: 12503833638
  • Fax: 12503833638
Mailing address:
  • Phone: 12503833638
  • Fax: 12503833638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberA72284
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: