Provider Demographics
NPI:1003070780
Name:FLYNN, JERRY PAUL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:PAUL
Last Name:FLYNN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JERALD
Other - Middle Name:PAUL
Other - Last Name:FLYNN
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2816
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:AK
Mailing Address - Zip Code:99664-2816
Mailing Address - Country:US
Mailing Address - Phone:907-491-0645
Mailing Address - Fax:888-723-1672
Practice Address - Street 1:417 1ST AVE
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:AK
Practice Address - Zip Code:99664-0365
Practice Address - Country:US
Practice Address - Phone:907-224-5205
Practice Address - Fax:907-224-7428
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLL17668390200000X
AK7109207Q00000X
CO52680207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO96608226Medicaid
AKMD9543Medicaid
CO96608226Medicaid