Healthcare Provider Details

I. General information

NPI: 1942259684
Provider Name (Legal Business Name): JOSEPH D. FLYNN D. O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 09/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 N WASHINGTON AVE
TITUSVILLE FL
32796-2163
US

IV. Provider business mailing address

PO BOX 3148
INDIANAPOLIS IN
46206-3148
US

V. Phone/Fax

Practice location:
  • Phone: 321-268-6192
  • Fax:
Mailing address:
  • Phone: 855-206-8407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberOS0004494
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: