Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | OS6311 | FL |
NPI | 1043239866 |
---|---|
Provider Name | Edwin D. Flanagan |
First Address | Stuart, FL 34995-0417 |
Second Address | Port St Lucie, FL 34952-7564 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 21/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
370979500 | (05) | FL |
F31262 | (02) | FL |