Provider Demographics
NPI:1124240064
Name:FLYNN, JAMES RAPHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RAPHAEL
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 1:6 COTTAGE GROVE WOODS SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2101
Mailing Address - Country:US
Mailing Address - Phone:319-362-1453
Mailing Address - Fax:
Practice Address - Street 1:947 14TH AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-2610
Practice Address - Country:US
Practice Address - Phone:319-363-0416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16877207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAAF7911200OtherDEA