Healthcare Provider Details

I. General information

NPI: 1275537060
Provider Name (Legal Business Name): WILLIAM J FLYNN M.D.,P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 12/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 HARRISON AVE
PANAMA CITY FL
32405-4549
US

IV. Provider business mailing address

2211 HARRISON AVE
PANAMA CITY FL
32405-4549
US

V. Phone/Fax

Practice location:
  • Phone: 850-763-2555
  • Fax: 850-763-9374
Mailing address:
  • Phone: 850-763-2555
  • Fax: 850-763-9374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME46709
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: