Provider Demographics
NPI:1851579650
Name:RICHARD A. FLAIZ
Entity Type:Organization
Organization Name:RICHARD A. FLAIZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:FLAIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACS
Authorized Official - Phone:541-567-2270
Mailing Address - Street 1:600 NW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-8605
Mailing Address - Country:US
Mailing Address - Phone:541-567-2270
Mailing Address - Fax:541-567-4153
Practice Address - Street 1:600 NW 11TH ST
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-8605
Practice Address - Country:US
Practice Address - Phone:541-567-2270
Practice Address - Fax:541-567-4153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD12591207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR012448Medicaid
OR012448Medicaid