Provider Demographics
NPI:1396735858
Name:FLICK, DAVID ARTHUR (MD, PHD, PA)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ARTHUR
Last Name:FLICK
Suffix:
Gender:M
Credentials:MD, PHD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4306 3RD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-2121
Mailing Address - Country:US
Mailing Address - Phone:850-718-2886
Mailing Address - Fax:850-718-2887
Practice Address - Street 1:4306 3RD AVE STE B
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-2121
Practice Address - Country:US
Practice Address - Phone:850-718-2886
Practice Address - Fax:850-718-2887
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLME61264174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372513800Medicaid
FL18250OtherBCBSFL
FL18250XOtherMEDICARE PTAN
FL372513800Medicaid