Provider Demographics
NPI:1457627853
Name:FLAGG, BRUCE (DO)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:FLAGG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2041 POLK ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-2525
Mailing Address - Country:US
Mailing Address - Phone:650-898-7604
Mailing Address - Fax:650-851-0931
Practice Address - Street 1:2041 POLK ST
Practice Address - Street 2:SUITE E
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-2525
Practice Address - Country:US
Practice Address - Phone:650-898-7604
Practice Address - Fax:650-851-0931
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAR20A5309208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice