Individual
JEFFREY ROBERT FLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, ATC
Contact information
Practice address
890 W ELLIOT RD, SUITE 103, GILBERT, AZ 85233-5102
(480) 214-4466
Mailing address
890 W ELLIOT RD, SUITE 103, GILBERT, AZ 85233-5102
(480) 214-4466
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
0090
AZ
363A00000X
Physician Assistant
Primary
5473
AZ
Other
Enumeration date
02/18/2010
Last updated
06/03/2014
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