Provider Demographics
NPI:1619254562
Name:FRANK B FLINT MD MEDICAL CORP
Entity Type:Organization
Organization Name:FRANK B FLINT MD MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:BRYCE
Authorized Official - Last Name:FLINT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-440-2427
Mailing Address - Street 1:PO BOX 12557
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92022-2557
Mailing Address - Country:US
Mailing Address - Phone:619-440-2427
Mailing Address - Fax:619-447-7310
Practice Address - Street 1:11822 NORTHILL TER
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:CA
Practice Address - Zip Code:92040-3723
Practice Address - Country:US
Practice Address - Phone:619-440-2427
Practice Address - Fax:619-447-7310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-07
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC25362208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C253620Medicaid
CA00C253620Medicaid
CAC25362Medicare PIN