Provider Demographics
NPI:1376595652
Name:FLYNN, GREGORY THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:THOMAS
Last Name:FLYNN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 152199
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33684-2199
Mailing Address - Country:US
Mailing Address - Phone:813-872-9200
Mailing Address - Fax:813-871-3110
Practice Address - Street 1:2808 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6306
Practice Address - Country:US
Practice Address - Phone:813-872-9200
Practice Address - Fax:813-871-3110
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME37627207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD21804Medicare UPIN
FL59297Medicare PIN