Provider Demographics
NPI:1275530602
Name:FLORY, DOUGLAS ALAN (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ALAN
Last Name:FLORY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8141 S EMERSON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8561
Mailing Address - Country:US
Mailing Address - Phone:317-888-1051
Mailing Address - Fax:317-888-1541
Practice Address - Street 1:8141 S EMERSON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8561
Practice Address - Country:US
Practice Address - Phone:317-888-1051
Practice Address - Fax:317-888-1591
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052068207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200272920Medicaid
G34814Medicare UPIN
IN219850001Medicare PIN