1033264486 NPI number — DR. RODERICK JA-DAVID, MICHAEL FLOWERS DO

Table of content: DR. RODERICK JA-DAVID, MICHAEL FLOWERS DO (NPI 1033264486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033264486 NPI number — DR. RODERICK JA-DAVID, MICHAEL FLOWERS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLOWERS
Provider First Name:
RODERICK
Provider Middle Name:
JA-DAVID, MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033264486
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7395 SOUTH HOUGHTON RD
Provider Second Line Business Mailing Address:
STE 129 SOUTHERN ARIZONA VA HEALTH CARE SYSTEMS SE CBOC
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85747-3305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-664-1831
Provider Business Mailing Address Fax Number:
520-664-1842

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7395 SOUTH HOUGHTON ROAD, SUITE 129
Provider Second Line Business Practice Location Address:
SOUTHERN ARIZONA VA HEALTH CARE SYSTEMS, SE CBOC
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85747-3305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-664-1831
Provider Business Practice Location Address Fax Number:
520-664-1842
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  2642 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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