Healthcare Provider Details

I. General information

NPI: 1083751168
Provider Name (Legal Business Name): DONALD L FLORY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CATALINA ST.
EL PRADO NM
87529
US

IV. Provider business mailing address

HCR 74 BOX 21407
EL PRADO NM
87529
US

V. Phone/Fax

Practice location:
  • Phone: 515-751-3848
  • Fax:
Mailing address:
  • Phone: 515-751-3848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY4223
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: