Provider Demographics
NPI:1447462510
Name:RICHARD J FLANIGAN MD
Entity type:Organization
Organization Name:RICHARD J FLANIGAN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHACON-JARAMILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-439-2456
Mailing Address - Street 1:8055 E TUFTS AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-2854
Mailing Address - Country:US
Mailing Address - Phone:303-357-2559
Mailing Address - Fax:720-572-5112
Practice Address - Street 1:4700 E ILIFF AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6025
Practice Address - Country:US
Practice Address - Phone:303-584-8900
Practice Address - Fax:720-524-9475
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICHARD J FLANIGAN MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-03
Last Update Date:2018-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18128174400000X
CODR.0018128207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC 808421Medicare PIN
COC29851Medicare ID - Type Unspecified
COD28205Medicare UPIN
COC 808422Medicare PIN