Provider Demographics
NPI:1386790988
Name:FLYNN, ANN DEBOURCY (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:DEBOURCY
Last Name:FLYNN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:CHRISTINE
Other - Last Name:DEBOURCY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:30 N 1900 E
Mailing Address - Street 2:SOM 4R118
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0002
Mailing Address - Country:US
Mailing Address - Phone:801-581-7803
Mailing Address - Fax:801-581-7476
Practice Address - Street 1:30 N 1900 E
Practice Address - Street 2:SOM 4R118
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0002
Practice Address - Country:US
Practice Address - Phone:801-581-7803
Practice Address - Fax:801-581-7476
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01071372A207R00000X, 207RG0100X
UT8525129-1205207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000772850OtherANTHEM
INP01163477OtherRAILROAD MEDICARE
IN201078440Medicaid
INM400073291Medicare PIN