Provider Demographics
NPI:1457912842
Name:FLAGG, JOSEPH ANDREW (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ANDREW
Last Name:FLAGG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 KIRK CIR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2372
Mailing Address - Country:US
Mailing Address - Phone:508-648-5196
Mailing Address - Fax:
Practice Address - Street 1:4889 S CONGRESS AVE STE 100
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-4762
Practice Address - Country:US
Practice Address - Phone:561-964-1212
Practice Address - Fax:561-461-8758
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9115990208800000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No208800000XAllopathic & Osteopathic PhysiciansUrology