Provider Demographics
NPI:1053564682
Name:FLYNN, STEVEN ANTHONY (BOCO, CFO)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ANTHONY
Last Name:FLYNN
Suffix:
Gender:M
Credentials:BOCO, CFO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21616 N MILL RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-9457
Mailing Address - Country:US
Mailing Address - Phone:501-257-1610
Mailing Address - Fax:501-257-1624
Practice Address - Street 1:2200 FORT ROOTS DR
Practice Address - Street 2:BLDG. 89, RM101
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-1709
Practice Address - Country:US
Practice Address - Phone:501-257-1610
Practice Address - Fax:501-257-1624
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
BOC36416OtherBOARD OF CERTIFICATION
CF00389OtherAMERICAN BOARD FOR CERTIFICATION