Healthcare Provider Details

I. General information

NPI: 1164508438
Provider Name (Legal Business Name): JOSEPH T FLYNN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2006
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE M/S A-7931
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

926 FEDERAL AVE E
SEATTLE WA
98102-4531
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2524
  • Fax:
Mailing address:
  • Phone: 206-987-2524
  • Fax: 206-987-2636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number47970
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: