Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 0688 | TX |
NPI | 1215911250 |
---|---|
Provider Name | Thomas Lynn Flick |
First Address | Sherman, TX 75090-1744 |
Second Address | Sherman, TX 75090-1744 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 17/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
084925901 | (05) | TX |
T13285 | (02) | TX |