Healthcare Provider Details

I. General information

NPI: 1083945927
Provider Name (Legal Business Name): DONALD L FLORY PHD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CATALINA COURT
EL PRADO NM
87529
US

IV. Provider business mailing address

HC 74 BOX 21407
EL PRADO NM
87529-9514
US

V. Phone/Fax

Practice location:
  • Phone: 575-751-3848
  • Fax:
Mailing address:
  • Phone: 575-751-3848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0965
License Number StateNM

VIII. Authorized Official

Name: DR. DONALD L FLORY
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 575-751-3848