Healthcare Provider Details

I. General information

NPI: 1285772038
Provider Name (Legal Business Name): BRENDAN JEROME FLYNN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 AUSTIN CREEK RD
CAZADERO CA
95421-9749
US

IV. Provider business mailing address

1600 AUSTIN CREEK RD
CAZADERO CA
95421-9749
US

V. Phone/Fax

Practice location:
  • Phone: 707-632-0023
  • Fax: 707-632-5332
Mailing address:
  • Phone: 707-632-0023
  • Fax: 707-632-5332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA043849
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: