Healthcare Provider Details

I. General information

NPI: 1780181040
Provider Name (Legal Business Name): MR. DEAUNTAE FLANAGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4165 OLD DOWLEN RD
BEAUMONT TX
77706-6608
US

IV. Provider business mailing address

4165 OLD DOWLEN RD
BEAUMONT TX
77706-6608
US

V. Phone/Fax

Practice location:
  • Phone: 757-806-8218
  • Fax:
Mailing address:
  • Phone: 757-806-8218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: