Provider Demographics
NPI:1679596308
Name:FLORY, DAVID RUSSELL (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:RUSSELL
Last Name:FLORY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2100 LAKESIDE BLVD
Mailing Address - Street 2:STE 250
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4351
Mailing Address - Country:US
Mailing Address - Phone:907-452-2700
Mailing Address - Fax:801-733-5618
Practice Address - Street 1:1650 COWLES ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5925
Practice Address - Country:US
Practice Address - Phone:800-945-9877
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4238207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD4238Medicaid
AK193928800OtherUS DEPT OF LABOR
AKMD4238Medicaid
AK050080558Medicare ID - Type UnspecifiedRAILROAD MEDICARE
AKK151075Medicare PIN