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NPI Code Detail

MEDICARE: DR. KENNETH GEORGE FLANAGAN MD

MEDICARE: DR. KENNETH GEORGE FLANAGAN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianG-042072CA
2207ZP0102XAnatomic Pathology & Clinical Pathology Physician23652AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
123652OTHERAZMEDICAL LIC
2DR.0053599OTHERCOMEDICAL LIC
3G-042072OTHERCAMED LIC

General Provider Information

NPI Number : 1760464853
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH GEORGE FLANAGAN MD
Provider Business Mailing Address
First Line : 14200 W CELEBRATE LIFE WAY
Second Line :
City : GOODYEAR
State : AZ
Zip : 85338-3007
Country : US
Telephone Number : 623-207-3000
Fax Number :
Provider Business Practice Location Address
First Line : 14200 W CELEBRATE LIFE WAY
Second Line :
City : GOODYEAR
State : AZ
Zip : 85338-3007
Country : US
Telephone Number : 623-207-3000
Fax Number : 623-207-3717
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2005
Last Update Date : 11/10/2015

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