Provider Demographics
NPI:1871948505
Name:FLYNN, RICHARD SPENCER (DOM)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:SPENCER
Last Name:FLYNN
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4735 GROVE POINT DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-5206
Mailing Address - Country:US
Mailing Address - Phone:813-770-2372
Mailing Address - Fax:
Practice Address - Street 1:2106 BISPHAM RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-5522
Practice Address - Country:US
Practice Address - Phone:941-923-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3368171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist