Provider Demographics
NPI:1689908832
Name:FLAGG, MARTHA L (NP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:L
Last Name:FLAGG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 MEDICAL DR
Mailing Address - Street 2:STE 500
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3342
Mailing Address - Country:US
Mailing Address - Phone:210-576-5306
Mailing Address - Fax:210-694-0645
Practice Address - Street 1:4330 MEDICAL DR
Practice Address - Street 2:STE 500
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3342
Practice Address - Country:US
Practice Address - Phone:210-576-5306
Practice Address - Fax:210-694-0645
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP118220363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB138824OtherWELLMED MEDICARE
TX208412102Medicaid
TX8L21977Medicare PIN
TXTXB138824OtherWELLMED MEDICARE