MEDICARE: ROBERT FLAKE DPM

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	0105	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477541043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT FLAKE DPM

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 C
City	:	PINETOP
State	:	AZ
Zip	:	85935-7027
Country	:	US
Telephone Number	:	928-367-3701
Fax Number	:	928-367-0801

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	07/08/2007

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Directions to “ ROBERT FLAKE DPM” Practice Location

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