Provider Demographics
NPI:1760575468
Name:FLEMMING, DAVID R (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:FLEMMING
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 1:757 PACIFIC STREET
Mailing Address - Street 2:SUITE D1
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2872
Mailing Address - Country:US
Mailing Address - Phone:831-373-4304
Mailing Address - Fax:831-373-0535
Practice Address - Street 1:757 PACIFIC STREET
Practice Address - Street 2:SUITE D1
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2872
Practice Address - Country:US
Practice Address - Phone:831-373-4304
Practice Address - Fax:831-373-0535
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG775582085R0001X
CAG73785208800000X, 2088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G737850Medicaid
CA00G737850Medicare ID - Type Unspecified
CA00G737850Medicaid
CA00G737851Medicare ID - Type UnspecifiedSECOND LOCATION ID