Provider Demographics
NPI:1255000980
Name:FLAGG, ROYAL DOMINGO
Entity Type:Individual
Prefix:
First Name:ROYAL
Middle Name:DOMINGO
Last Name:FLAGG
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 1:1919 HEIZER ST APT C
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-2750
Mailing Address - Country:US
Mailing Address - Phone:785-210-6085
Mailing Address - Fax:
Practice Address - Street 1:1919 HEIZER ST APT C
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-2750
Practice Address - Country:US
Practice Address - Phone:785-210-6085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst