Individual
IAN DALLAS BRODIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
911 ELECTRIC AVE, SEAL BEACH, CA 90740
(562) 594-8635
(562) 594-6009
Mailing address
911 ELECTRIC AVE, SEAL BEACH, CA 90740
(562) 594-8635
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
A29773
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A29773
STATE LICENSE
CA
Enumeration date
08/03/2006
Last updated
07/08/2007
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