Provider Demographics
NPI:1194381871
Name:FLATT, DESTRY GRAHAM
Entity Type:Individual
Prefix:
First Name:DESTRY
Middle Name:GRAHAM
Last Name:FLATT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 OAK RD APT 13201
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8895
Mailing Address - Country:US
Mailing Address - Phone:325-668-1505
Mailing Address - Fax:
Practice Address - Street 1:720 1/2 ROLLINGBROOK DR
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-4059
Practice Address - Country:US
Practice Address - Phone:281-369-8672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other