Healthcare Provider Details

I. General information

NPI: 1669812855
Provider Name (Legal Business Name): ZACHARY ANTHONY FLYNN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 11/01/2020
Certification Date: 11/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11209 N TATUM BLVD STE 100
PHOENIX AZ
85028-3000
US

IV. Provider business mailing address

11209 N TATUM BLVD STE 100
PHOENIX AZ
85028-3000
US

V. Phone/Fax

Practice location:
  • Phone: 602-973-3888
  • Fax: 602-973-3028
Mailing address:
  • Phone: 602-973-3888
  • Fax: 602-973-3028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0827
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: