1962476465 NPI number — DR. DALE E. FLENYOL PHD, CRNA

Table of content: DR. DALE E. FLENYOL PHD, CRNA (NPI 1962476465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962476465 NPI number — DR. DALE E. FLENYOL PHD, CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLENYOL
Provider First Name:
DALE
Provider Middle Name:
E.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FLENYOL
Provider Other First Name:
DALE
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1962476465
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8427 LAKEVIEW TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKLAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33076-4140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-643-4266
Provider Business Mailing Address Fax Number:
954-749-4024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8427 LAKEVIEW TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKLAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-643-4266
Provider Business Practice Location Address Fax Number:
954-749-4024
Provider Enumeration Date:
02/14/2006

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: 367500000X , with the licence number:  0129380 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 2018045390 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: ARNP1936592 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 020288300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: G1932T . This is a "MEDCARE UPN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: G1932 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: G1932U . This is a "MEDICARE PIN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: G1932Y . This is a "MEDICARE PIN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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