Healthcare Provider Details

I. General information

NPI: 1144481821
Provider Name (Legal Business Name): BENJAMIN J. FLANNERY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 NORTH AVE
NORTHFIELD MN
55057-4854
US

IV. Provider business mailing address

2000 NORTH AVE
NORTHFIELD MN
55057-4854
US

V. Phone/Fax

Practice location:
  • Phone: 507-646-1494
  • Fax:
Mailing address:
  • Phone: 507-646-1494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number39346
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number54106
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: