Provider Demographics
NPI:1457344624
Name:FLANIGAN, MARK D (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:FLANIGAN
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 1:9191 HURON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80260-6842
Mailing Address - Country:US
Mailing Address - Phone:303-225-0080
Mailing Address - Fax:303-487-9103
Practice Address - Street 1:9191 HURON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80260-6842
Practice Address - Country:US
Practice Address - Phone:303-225-0080
Practice Address - Fax:303-487-9103
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24462207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01244623Medicaid
D60860Medicare UPIN
498848Medicare ID - Type Unspecified