Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | G40083 | CA |
NPI | 1003167289 |
---|---|
Provider Name | Dr. Michael Dennis Flanigan |
First Address | Pacific Palisades, CA 90272-4349 |
Second Address | Pacific Palisades, CA 90272-4349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2012 |
Last Update Date | 27/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G40083 | CALIFONIA MEDICAL LICENSE (01) | CA |