Provider Demographics
NPI:1275627648
Name:FLAMMER, DONALD P (PHD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:P
Last Name:FLAMMER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:8312 KASEMAN CT NE
Practice Address - Street 2:PMG KASEMAN BEHAVIORAL MEDICINE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7639
Practice Address - Country:US
Practice Address - Phone:505-291-5300
Practice Address - Fax:505-291-5301
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM121103TP0814X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000N8768Medicaid
NM000N8768Medicaid