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NPI Code Detail

MEDICARE: TRACY FLYNN

MEDICARE: TRACY FLYNN
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
1374700000XTechnician7463800OR

General Provider Information

NPI Number : 1871917310
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY FLYNN
Provider Business Mailing Address
First Line : 5538 NE 24TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97211-6206
Country : US
Telephone Number : 503-351-7558
Fax Number :
Provider Business Practice Location Address
First Line : 3320 SE HOLGATE BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97202-3459
Country : US
Telephone Number : 503-872-1272
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2014
Last Update Date : 02/04/2014

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Directions to “ TRACY FLYNN ” Practice Location

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