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General NPI Number Information
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NPI Number | 1477541043
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Entity Type | Individual
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Provider Name | ROBERT FLAKE DPM
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Gender | Male
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Dates
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Enumeration Date | 10/07/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 728 E WHITE MOUNTAIN BLVD SUITE C
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City | PINETOP
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State | AZ
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Zip | 85935-7027
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Country | US
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Telephone | 928-367-3701
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Fax | 928-367-0801
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Provider Business Mailing Address
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Address Line | PO BOX 430D
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City | PINETOP
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State | AZ
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Zip | 85935-0416
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Country | US
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Telephone | 928-367-3701
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Fax | 928-367-0801
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 0105
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License Number State | AZ
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