Healthcare Provider Details

I. General information

NPI: 1053322289
Provider Name (Legal Business Name): RICHARD FLYNN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4124 BLANDING BLVD
JACKSONVILLE FL
32210-5419
US

IV. Provider business mailing address

4124 BLANDING BLVD
JACKSONVILLE FL
32210-5419
US

V. Phone/Fax

Practice location:
  • Phone: 904-861-3627
  • Fax: 904-961-2692
Mailing address:
  • Phone: 904-861-3627
  • Fax: 904-961-2692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME58593
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: