Provider Demographics
NPI:1114981396
Name:FLANNERY, RYAN ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:ANDREW
Last Name:FLANNERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52353-0909
Mailing Address - Country:US
Mailing Address - Phone:319-653-7291
Mailing Address - Fax:319-653-7440
Practice Address - Street 1:1230 S IOWA AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353-1144
Practice Address - Country:US
Practice Address - Phone:319-653-7291
Practice Address - Fax:319-653-7440
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34659207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAH46033Medicare UPIN
IA1690Medicare ID - Type Unspecified