Provider Demographics
NPI:1184666562
Name:FLANNERY, ANTHONY W (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:W
Last Name:FLANNERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANTHONY
Other - Middle Name:W
Other - Last Name:FLANNERY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:859-858-9355
Mailing Address - Fax:859-858-0416
Practice Address - Street 1:200 RICE ST
Practice Address - Street 2:
Practice Address - City:WILMORE
Practice Address - State:KY
Practice Address - Zip Code:40390-1359
Practice Address - Country:US
Practice Address - Phone:859-858-9355
Practice Address - Fax:859-858-0416
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22566207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64225667Medicaid
KY64225667Medicaid
KYC74773Medicare UPIN
KY1599101Medicare PIN