Healthcare Provider Details

I. General information

NPI: 1053564682
Provider Name (Legal Business Name): STEVEN ANTHONY FLYNN B.O.C.O., C.F.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 FORT ROOTS DR BLDG. 89, RM101
NORTH LITTLE ROCK AR
72114-1709
US

IV. Provider business mailing address

21616 N MILL RD
LITTLE ROCK AR
72206-9457
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-1610
  • Fax: 501-257-1624
Mailing address:
  • Phone: 501-257-1610
  • Fax: 501-257-1624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: