Healthcare Provider Details

I. General information

NPI: 1376595652
Provider Name (Legal Business Name): GREGORY THOMAS FLYNN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1948 CAROLINA AVE NE
SAINT PETERSBURG FL
33703-3410
US

IV. Provider business mailing address

1948 CAROLINA AVE NE
SAINT PETERSBURG FL
33703-3410
US

V. Phone/Fax

Practice location:
  • Phone: 813-465-9686
  • Fax:
Mailing address:
  • Phone: 813-465-9686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME37627
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: