Provider Demographics
NPI:1598784563
Name:FLECK, ROBIN M (MD)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:M
Last Name:FLECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 WHIPPLE STREET
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1787
Mailing Address - Country:US
Mailing Address - Phone:928-778-0808
Mailing Address - Fax:928-778-4788
Practice Address - Street 1:242 WHIPPLE STREET
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1787
Practice Address - Country:US
Practice Address - Phone:928-778-0808
Practice Address - Fax:928-778-4788
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ31062207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0772850OtherBC/BA PROVIDER #
AZ2Z3689OtherACS/HEALTHNET
AZ2Z3689OtherACS/HEALTHNET
AZB95646Medicare UPIN
AZAZ0772850OtherBC/BA PROVIDER #