Provider Demographics
NPI:1184014078
Name:FLYNN, BRIAN F (LMT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:F
Last Name:FLYNN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 VALVERDE ST APT B
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-7066
Mailing Address - Country:US
Mailing Address - Phone:575-779-5473
Mailing Address - Fax:
Practice Address - Street 1:824 PASEO DEL PUEBLO NORTE
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6482
Practice Address - Country:US
Practice Address - Phone:575-779-5473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7210174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist