Healthcare Provider Details

I. General information

NPI: 1619254562
Provider Name (Legal Business Name): FRANK B FLINT MD MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2011
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11822 NORTHILL TER
LAKESIDE CA
92040-3723
US

IV. Provider business mailing address

PO BOX 12557
EL CAJON CA
92022-2557
US

V. Phone/Fax

Practice location:
  • Phone: 619-440-2427
  • Fax: 619-447-7310
Mailing address:
  • Phone: 619-440-2427
  • Fax: 619-447-7310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC25362
License Number StateCA

VIII. Authorized Official

Name: FRANK BRYCE FLINT
Title or Position: PRESIDENT
Credential: MD.
Phone: 619-440-2427