Healthcare Provider Details

I. General information

NPI: 1235171000
Provider Name (Legal Business Name): EDWARD V. FLAKE DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 E WHITE MOUNTAIN BLVD SUITE 3C
PINETOP AZ
85935-7027
US

IV. Provider business mailing address

PO BOX 430D
PINETOP AZ
85935-0416
US

V. Phone/Fax

Practice location:
  • Phone: 928-367-3701
  • Fax: 928-367-0801
Mailing address:
  • Phone: 928-367-3701
  • Fax: 928-367-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: EDWARD FLAKE
Title or Position: OWNER
Credential:
Phone: 928-367-3701