Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | ||
Y | 222Z00000X | Podiatrist |
NPI | 1053564682 |
---|---|
Provider Name | Mr. Steven Anthony Flynn |
First Address | Little Rock, AR 72206-9457 |
Second Address | North Little Rock, AR 72114-1709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2008 |
Last Update Date | 28/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BOC36416 | BOARD OF CERTIFICATION (01) | |
CF00389 | AMERICAN BOARD FOR CERTIFICATION (01) |