Healthcare Provider Details

I. General information

NPI: 1811057458
Provider Name (Legal Business Name): JOSEPH WAYNE FLYNN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 BATES STREET
LEWISTON ME
04240
US

IV. Provider business mailing address

12 BATES STREET P.O. BOX 1288
LEWISTON ME
04243-1288
US

V. Phone/Fax

Practice location:
  • Phone: 207-784-4539
  • Fax: 207-784-2868
Mailing address:
  • Phone: 207-784-4539
  • Fax: 207-784-2868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number011924
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number78-160
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: