Healthcare Provider Details

I. General information

NPI: 1972530822
Provider Name (Legal Business Name): TIMOTHY C FLYNN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TIMOTHY CARLYLE FLYNN

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 02/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

PO BOX 918025
ORLANDO FL
32891-8025
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0152
  • Fax: 352-265-8966
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME44679
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: