Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | M11707 | ID |
NPI | 1447449574 |
---|---|
Provider Name | Daniel P Flynn |
First Address | Boise, ID 83712 |
Second Address | Boise, ID 83712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2007 |
Last Update Date | 29/12/2012 |