Provider Demographics
NPI:1235171000
Name:EDWARD V. FLAKE DPM PC
Entity Type:Organization
Organization Name:EDWARD V. FLAKE DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-367-3701
Mailing Address - Street 1:PO BOX 430D
Mailing Address - Street 2:
Mailing Address - City:PINETOP
Mailing Address - State:AZ
Mailing Address - Zip Code:85935-0416
Mailing Address - Country:US
Mailing Address - Phone:928-367-3701
Mailing Address - Fax:928-367-0801
Practice Address - Street 1:728 E WHITE MOUNTAIN BLVD
Practice Address - Street 2:SUITE 3C
Practice Address - City:PINETOP
Practice Address - State:AZ
Practice Address - Zip Code:85935-7027
Practice Address - Country:US
Practice Address - Phone:928-367-3701
Practice Address - Fax:928-367-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty