Provider Demographics
NPI:1306960455
Name:FLANIGAN, KEVIN M (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:FLANIGAN
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:POB 727
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642
Mailing Address - Country:US
Mailing Address - Phone:480-677-9421
Mailing Address - Fax:
Practice Address - Street 1:300 HILLTOP DR.
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642
Practice Address - Country:US
Practice Address - Phone:480-677-9421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058320208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ818198Medicaid
AZ818198Medicaid
AZH96855Medicare UPIN
AZ8HBT04Medicare ID - Type UnspecifiedMEDICARE PART B - PINON
AZ8HBT03Medicare ID - Type UnspecifiedMEDICARE PART B - CHINLE