=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679559132
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK NICHOLAS FLANAGAN DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2005
-----------------------------------------------------
Last Update Date | 01/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 888 S KING ST
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96813-3097
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-522-4000
-----------------------------------------------------
Fax | 808-522-4062
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 740241
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90074-0241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-522-4000
-----------------------------------------------------
Fax | 808-522-4062
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | DOS-2253
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------