Healthcare Provider Details

I. General information

NPI: 1194831776
Provider Name (Legal Business Name): KYLE JERRY FLESHER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 W PLAZA DR
TALLAHASSEE FL
32308-5324
US

IV. Provider business mailing address

1608 W PLAZA DR
TALLAHASSEE FL
32308-5324
US

V. Phone/Fax

Practice location:
  • Phone: 850-942-2400
  • Fax:
Mailing address:
  • Phone: 850-942-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO2348
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: