Provider Demographics
NPI:1356669477
Name:FLIR INC
Entity type:Organization
Organization Name:FLIR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PRACTICE/PLASTIC SURGERY
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:307-203-9239
Mailing Address - Street 1:622 N 900 E
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-1695
Mailing Address - Country:US
Mailing Address - Phone:307-203-9239
Mailing Address - Fax:
Practice Address - Street 1:1027 S RAINBOW BLVD
Practice Address - Street 2:STE 308
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-6232
Practice Address - Country:US
Practice Address - Phone:307-203-9239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD07612Medicare UPIN