Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1194379073 |
---|---|
Provider Name | Cody Flanders |
First Address | Klamath Falls, OR 97603-2612 |
Second Address | Klamath Falls, OR 97603-2612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2019 |
Last Update Date | 29/07/2019 |