Vanowen Medical Group, Inc

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

License

A47749 Issued in CA

Legal business name

VANOWEN MEDICAL GROUP, INC

Practice address

16927 Vanowen St Ste 4
Lake Balboa, CA 91406-4582

Phone

(818) 483-4717

Fax

(818) 483-4718

NPI assigned

Dec 6, 2017

Last updated

Dec 27, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

George D Flanigan III, MD

Title

Owner/Director

Phone

(818) 483-4717

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1512518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1514332800000",
    "number": "1144735747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16927 VANOWEN ST STE 4",
            "city": "LAKE BALBOA",
            "state": "CA",
            "postal_code": "914064582",
            "telephone_number": "818-483-4717",
            "fax_number": "818-483-4718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16927 VANOWEN ST STE 4",
            "city": "LAKE BALBOA",
            "state": "CA",
            "postal_code": "914064582",
            "telephone_number": "818-483-4717",
            "fax_number": "818-483-4718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANOWEN MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-06",
        "last_updated": "2017-12-27",
        "status": "A",
        "authorized_official_last_name": "FLANIGAN",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "818-483-4717",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "A47749",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL BOARD OF CALIFORNIA",
            "identifier": "A47749",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Geriatric Medicine (Family Medicine) Physician in Lake Balboa, CA
• Providers in Lake Balboa, CA by specialty
• Geriatric Medicine (Family Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.