Healthcare Provider Details

I. General information

NPI: 1326028358
Provider Name (Legal Business Name): DIANE M FLYNN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
TACOMA WA
98431
US

IV. Provider business mailing address

DEPT OF REHABILITATIVE MEDICINE 9040 JACKSON AVE MAMC
TACOMA WA
98431-9702
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-2252
  • Fax: 253-968-2608
Mailing address:
  • Phone: 253-968-2065
  • Fax: 253-968-2608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00045959
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: