Healthcare Provider Details

I. General information

NPI: 1619938222
Provider Name (Legal Business Name): PATRICK J FLYNN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6025 LAKE RD STE 110
WOODBURY MN
55125-1709
US

IV. Provider business mailing address

6025 LAKE RD STE 110
WOODBURY MN
55125-1709
US

V. Phone/Fax

Practice location:
  • Phone: 651-735-7414
  • Fax: 651-735-7414
Mailing address:
  • Phone: 651-735-7414
  • Fax: 651-735-7414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number23037
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: