Provider Demographics
NPI:1811048697
Name:FLASKAS, MARINA YURIEVNA (MD)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:YURIEVNA
Last Name:FLASKAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-324-6450
Mailing Address - Fax:
Practice Address - Street 1:703 S FLEISHEL AVE
Practice Address - Street 2:STE 4000
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2015
Practice Address - Country:US
Practice Address - Phone:903-606-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23208207R00000X, 207RC0000X
TXN1319207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8ED335OtherBCBS
TX75-0818167-015OtherTRICARE
TX75-2616977-019OtherTRICARE
TX8BC261OtherBCBS OF TEXAS
TXTIN PLUS 042OtherTRICARE
TXTIN PLUS 001OtherTRICARE
TX198507901Medicaid
TXTIN PLUS 029OtherTRICARE
TX198507902Medicaid
TX340590YS6PMedicare PIN
TX8BC261OtherBCBS OF TEXAS
TX75-0818167-015OtherTRICARE