Provider Demographics
NPI:1265129597
Name:FLAGG, BRYAN K JR
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:K
Last Name:FLAGG
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 N GOODMAN ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1185
Mailing Address - Country:US
Mailing Address - Phone:585-325-3145
Mailing Address - Fax:585-325-3188
Practice Address - Street 1:320 N GOODMAN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1185
Practice Address - Country:US
Practice Address - Phone:585-325-3145
Practice Address - Fax:585-325-3188
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist