Healthcare Provider Details

I. General information

NPI: 1114032265
Provider Name (Legal Business Name): J BRYAN FLYNN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAMES BRYAN FLYNN

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 SHORE DR
MARINETTE WI
54143
US

IV. Provider business mailing address

3301 W FOREST HOME AVE
MILWAUKEE WI
53215-2843
US

V. Phone/Fax

Practice location:
  • Phone: 715-735-7421
  • Fax: 715-735-4601
Mailing address:
  • Phone: 414-647-6326
  • Fax: 414-671-8860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number24915
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301044783
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: