Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 52680 | CO |
Y | 207Q00000X | Family Doctor | 7109 | AK |
NPI | 1003070780 |
---|---|
Provider Name | Dr. Jerry Paul Flynn JR. |
First Address | Seward, AK 99664-2816 |
Second Address | Seward, AK 99664-0365 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2008 |
Last Update Date | 28/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
96608226 | (05) | CO |
MD9543 | (05) | AK |