MEDICARE: ALEXANDER FLANAGIN

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
1	2255A2300X	Athletic Trainer
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1760861942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER FLANAGIN

Provider Business Mailing Address
First Line	:	4517 KIRKDALE DR
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-6234
Country	:	US
Telephone Number	:	573-999-1357
Fax Number	:

Provider Business Practice Location Address
First Line	:	4517 KIRKDALE DR
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-6234
Country	:	US
Telephone Number	:	573-999-1357
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2015
Last Update Date	:	05/21/2015

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Directions to “ ALEXANDER FLANAGIN ” Practice Location

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