Provider Demographics
NPI:1316964273
Name:FLACH, DAVID B (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:FLACH
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 1:4656 40TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4397
Mailing Address - Country:US
Mailing Address - Phone:701-234-8860
Mailing Address - Fax:701-234-8924
Practice Address - Street 1:4656 40TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4397
Practice Address - Country:US
Practice Address - Phone:701-234-8860
Practice Address - Fax:701-234-8924
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5202207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND15187Medicaid
MN070000392Medicare PIN
NDN716594Medicare PIN
ND15187Medicaid
NDN2038Medicare PIN