Provider Demographics
NPI:1730159823
Name:FLANAGAN, JOHN R III (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:FLANAGAN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 LANDA STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6163
Mailing Address - Country:US
Mailing Address - Phone:830-629-3614
Mailing Address - Fax:830-629-2438
Practice Address - Street 1:705 LANDA ST
Practice Address - Street 2:SUITE C
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6172
Practice Address - Country:US
Practice Address - Phone:210-887-7692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2964171W00000X, 207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No171W00000XOther Service ProvidersContractor
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137211216Medicaid
TXB95642Medicare UPIN
TXP00080240Medicare PIN
TX137211216Medicaid
TX8C0583Medicare PIN