Healthcare Provider Details

I. General information

NPI: 1952612954
Provider Name (Legal Business Name): RYAN MALLOY FLYNN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 MERCY HEALTH BLVD SUITE 525
CINCINNATI OH
45211-1105
US

IV. Provider business mailing address

2000 JOSEPH E SANKER BLVD
CINCINNATI OH
45212-1979
US

V. Phone/Fax

Practice location:
  • Phone: 513-841-7700
  • Fax: 513-841-7701
Mailing address:
  • Phone: 513-841-7400
  • Fax: 513-841-7402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number35128127
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: