Healthcare Provider Details

I. General information

NPI: 1447949011
Provider Name (Legal Business Name): MR. COLTON JAMES FLAHERTY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 PENNSYLVANIA AVE STE 690
FORT WORTH TX
76104-2133
US

IV. Provider business mailing address

9036 MAPLE RIDGE DR
NEWPORT MI
48166-9285
US

V. Phone/Fax

Practice location:
  • Phone: 817-761-7740
  • Fax: 817-761-7742
Mailing address:
  • Phone: 734-915-6797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA19454
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: