Provider Demographics
NPI:1942370879
Name:FLINNER, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:FLINNER
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 1:1405 HOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:WORLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82401
Mailing Address - Country:US
Mailing Address - Phone:307-347-2555
Mailing Address - Fax:307-347-9831
Practice Address - Street 1:1405 HOWELL AVE
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401
Practice Address - Country:US
Practice Address - Phone:307-347-2555
Practice Address - Fax:307-347-9831
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4625A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY104499100Medicaid
WYP00215311OtherRR MEDICARE
WY120726100Medicaid
WY05726001OtherBLUE CROSS BLUE SHIELD
WY836000025-24OtherTRICARE
WY836000025-24OtherTRICARE
WY104499100Medicaid
WYW20232Medicare PIN
WY05726001OtherBLUE CROSS BLUE SHIELD
WYP00215311OtherRR MEDICARE