Provider Demographics
NPI:1568467983
Name:FLANAGAN, CLINT (MD)
Entity Type:Individual
Prefix:DR
First Name:CLINT
Middle Name:
Last Name:FLANAGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4943 STATE HIGHWAY 52
Mailing Address - Street 2:STE 240
Mailing Address - City:DACONO
Mailing Address - State:CO
Mailing Address - Zip Code:80514-9100
Mailing Address - Country:US
Mailing Address - Phone:303-501-2600
Mailing Address - Fax:303-833-7017
Practice Address - Street 1:4943 STATE HIGHWAY 52
Practice Address - Street 2:STE 240
Practice Address - City:DACONO
Practice Address - State:CO
Practice Address - Zip Code:80514-9100
Practice Address - Country:US
Practice Address - Phone:303-501-2600
Practice Address - Fax:303-833-7017
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40955207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00830534Medicaid
I03248Medicare UPIN
COCO40953Medicare PIN