Provider Demographics
NPI:1619938222
Name:FLYNN, PATRICK J (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:FLYNN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:6025 LAKE RD
Mailing Address - Street 2:STE 110
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1709
Mailing Address - Country:US
Mailing Address - Phone:651-735-7414
Mailing Address - Fax:651-735-7414
Practice Address - Street 1:6025 LAKE RD
Practice Address - Street 2:STE 110
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1709
Practice Address - Country:US
Practice Address - Phone:651-735-7414
Practice Address - Fax:651-735-7414
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN23037207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3600777OtherMEDICA
MN1106312OtherUCARE MN
MN23323OtherAMERICA'S PPO
MN8T402FLOtherBLUE CROSS BLUE SHIELD MN
MNHP13298OtherHEALTHPARTNERS
MN0003690OtherPREFERRED ONE
WI30613600Medicaid
MN396085400Medicaid
MD406272800Medicaid
MN3600777OtherMEDICA
MNA94048Medicare UPIN
MN396085400Medicaid