Provider Demographics
NPI:1457324600
Name:FLANAGAN, KAREN ANN (D O)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S. TWINING ST., BLDG 760
Mailing Address - Street 2:42D MEDICAL GROUP
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36112
Mailing Address - Country:US
Mailing Address - Phone:334-953-5143
Mailing Address - Fax:334-953-8607
Practice Address - Street 1:300 S. TWINING ST., BLDG 760
Practice Address - Street 2:42D MEDICAL GROUP
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36112
Practice Address - Country:US
Practice Address - Phone:334-953-5143
Practice Address - Fax:334-953-8607
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO616207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009902780Medicaid
AL370014141Medicare PIN
AL000032852FLAMedicare ID - Type Unspecified
B30970Medicare UPIN