Provider Demographics
NPI:1770567745
Name:FLYNN, PATRICK R (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:R
Last Name:FLYNN
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 1:3900 LAKEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-5698
Mailing Address - Country:US
Mailing Address - Phone:707-765-3900
Mailing Address - Fax:
Practice Address - Street 1:3900 LAKEVILLE HWY
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-5698
Practice Address - Country:US
Practice Address - Phone:707-765-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80566207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G805660Medicaid
CA00G805660Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
CA00G805660Medicaid