Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0600X | Clinical Neurophysiologist | 85-176 | NM |
NPI | 1497756670 |
---|---|
Provider Name | Dr. Michael O. Flanagan |
First Address | Albuquerque, NM 87109-1103 |
Second Address | Albuquerque, NM 87109-1103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F39957 | (02) | |
F7519 | (05) | NM |