Healthcare Provider Details

I. General information

NPI: 1093076077
Provider Name (Legal Business Name): JAY FLYNN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 N DIXIE AVE
ELIZABETHTOWN KY
42701-2503
US

IV. Provider business mailing address

3900 AMBASSADOR DR STE 201
ANCHORAGE AK
99508-5922
US

V. Phone/Fax

Practice location:
  • Phone: 270-706-5275
  • Fax: 270-706-1051
Mailing address:
  • Phone: 907-729-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number112317
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number112317
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number112317
License Number StateAK
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberTP942
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: