Provider Demographics
NPI:1710957170
Name:FLANNAGAN, DUANE CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:CHARLES
Last Name:FLANNAGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SAINT CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-9053
Mailing Address - Country:US
Mailing Address - Phone:812-482-6424
Mailing Address - Fax:812-634-9701
Practice Address - Street 1:200 SAINT CHARLES ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-9053
Practice Address - Country:US
Practice Address - Phone:812-482-6424
Practice Address - Fax:812-634-9701
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026234207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00097857OtherRAILROAD MEDICARE
IN000000335549OtherANTHEM
IN10010925Medicaid
INP00097857OtherRAILROAD MEDICARE
IN000000335549OtherANTHEM