Provider Demographics
NPI:1699866822
Name:FLINT, GREGORY LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LYNN
Last Name:FLINT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:868 E RIVERSIDE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6019
Mailing Address - Country:US
Mailing Address - Phone:208-367-2864
Mailing Address - Fax:208-323-0310
Practice Address - Street 1:868 E RIVERSIDE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6019
Practice Address - Country:US
Practice Address - Phone:208-367-2864
Practice Address - Fax:208-323-0310
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2009-07-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDM3500207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID35006OtherBLUE CROSS OF IDAHO
ID000010004115OtherREGENCE BLUESHIELD OF ID
ID002486300Medicaid
ID070002801OtherRAILROAD MEDICARE
ID11109840Medicare PIN
ID002486300Medicaid
IDC36838Medicare UPIN