Healthcare Provider Details

I. General information

NPI: 1871948505
Provider Name (Legal Business Name): RICHARD SPENCER FLYNN DOM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 BISPHAM RD
SARASOTA FL
34231-5522
US

IV. Provider business mailing address

4735 GROVE POINT DR
TAMPA FL
33624-5206
US

V. Phone/Fax

Practice location:
  • Phone: 941-923-9355
  • Fax:
Mailing address:
  • Phone: 813-770-2372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number3368
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: