Provider Demographics
NPI:1295785145
Name:FLATLEY, PAUL G (DO)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:G
Last Name:FLATLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5656 E ORANGE BLOSSOM LN STE 5
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-8139
Mailing Address - Country:US
Mailing Address - Phone:602-601-7429
Mailing Address - Fax:602-601-7428
Practice Address - Street 1:5656 E ORANGE BLOSSOM LN STE 5
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-8139
Practice Address - Country:US
Practice Address - Phone:602-601-7429
Practice Address - Fax:602-601-7428
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31622083A0300X, 146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ504386Medicaid
AZG40568Medicare UPIN