Provider Demographics
NPI:1275537060
Name:FLYNN, WILLIAM J (MD,PA)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:FLYNN
Suffix:
Gender:M
Credentials:MD,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4549
Mailing Address - Country:US
Mailing Address - Phone:850-763-2555
Mailing Address - Fax:850-763-9374
Practice Address - Street 1:2211 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4549
Practice Address - Country:US
Practice Address - Phone:850-763-2555
Practice Address - Fax:850-763-9374
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46709174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30000OtherBLUE CROSS BLUE SHIELD
FL043444200Medicaid
FL043444200Medicaid
FL30000OtherBLUE CROSS BLUE SHIELD