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General NPI Number Information
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NPI Number | 1336327923
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Entity Type | Organization
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Legal Business Name | GREGORY L. FLINT M.D., P.C.
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 868 E RIVERSIDE DR SUITE 200
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City | EAGLE
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State | ID
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Zip | 83616-6019
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Country | US
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Telephone | 208-367-2864
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Fax | 208-323-0310
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Provider Business Mailing Address
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Address Line | 868 E RIVERSIDE DR SUITE 200
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City | EAGLE
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State | ID
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Zip | 83616-6019
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Country | US
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Telephone | 208-367-2864
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Fax | 208-323-0310
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | DR. GREGORY L. FLINT
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Credential | M.D.
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Telephone | 208-367-2864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | M3500
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License Number State | ID
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