Provider Demographics
NPI:1922071380
Name:FLAMING, JERRY L (DO)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:L
Last Name:FLAMING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2847
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-2847
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:531 N HIGHWAY 101 STE A
Practice Address - Street 2:
Practice Address - City:DEPOE BAY
Practice Address - State:OR
Practice Address - Zip Code:97341-9572
Practice Address - Country:US
Practice Address - Phone:541-765-3265
Practice Address - Fax:541-765-3260
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO11571207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR231076Medicaid
OR08WCGWZAMedicare ID - Type Unspecified
OR231076Medicaid