Provider Demographics
NPI:1285772038
Name:FLYNN, BRENDAN JEROME (MD)
Entity type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:JEROME
Last Name:FLYNN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1600 AUSTIN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CAZADERO
Mailing Address - State:CA
Mailing Address - Zip Code:95421-9749
Mailing Address - Country:US
Mailing Address - Phone:707-632-0023
Mailing Address - Fax:707-632-5332
Practice Address - Street 1:1600 AUSTIN CREEK RD
Practice Address - Street 2:
Practice Address - City:CAZADERO
Practice Address - State:CA
Practice Address - Zip Code:95421-9749
Practice Address - Country:US
Practice Address - Phone:707-632-0023
Practice Address - Fax:707-632-5332
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA043849207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology