MEDICARE: EDWARD V. FLAKE DPM PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1235171000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWARD V. FLAKE DPM PC

Provider Business Mailing Address
First Line	:	PO BOX 430D
Second Line	:
City	:	PINETOP
State	:	AZ
Zip	:	85935-0416
Country	:	US
Telephone Number	:	928-367-3701
Fax Number	:	928-367-0801

Provider Business Practice Location Address
First Line	:	728 E WHITE MOUNTAIN BLVD
Second Line	:	SUITE 3C
City	:	PINETOP
State	:	AZ
Zip	:	85935-7027
Country	:	US
Telephone Number	:	928-367-3701
Fax Number	:	928-367-0801

Authorized Official
Title or Position	:	OWNER
Name	:	EDWARD FLAKE
Credential	:
Telephone Number	:	928-367-3701

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	08/22/2020

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