Healthcare Provider Details

I. General information

NPI: 1396735858
Provider Name (Legal Business Name): DAVID ARTHUR FLICK MD, PHD, PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4306 3RD AVE STE B
MARIANNA FL
32446-2121
US

IV. Provider business mailing address

4306 3RD AVE STE B
MARIANNA FL
32446-2121
US

V. Phone/Fax

Practice location:
  • Phone: 850-718-2886
  • Fax: 850-718-2887
Mailing address:
  • Phone: 850-718-2886
  • Fax: 850-718-2887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberFLME61264
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: