Jerrold Neil Flyer, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

162603-1 Issued in NY

Practice address

90 Hope Dr
Building 6000
Mountain Home AFB, ID 83648-1057

Phone

(208) 828-7600

NPI assigned

Oct 6, 2005

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1417944240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4476 TUCK ST",
            "city": "MOUNTAIN HOME AFB",
            "state": "ID",
            "postal_code": "836481107",
            "telephone_number": "623-326-8092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 HOPE DR",
            "address_2": "BUILDING 6000",
            "city": "MOUNTAIN HOME AFB",
            "state": "ID",
            "postal_code": "836481057",
            "telephone_number": "208-828-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLYER",
        "first_name": "JERROLD",
        "middle_name": "NEIL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "162603-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Le Ann Marie Egan
• Zane Elliott, IDMT
• David J Emert
• Anthony Ewell-Kollmann, DMD
• Teagan Ferguson, DPT
• Craig Loyd Folsom, D.D.S.
• Dakota T Freve, M.D.
• Heather Marie Funk, MS, RDN, LDN
• Eric Nathain Galindo Jr., IDMT
• Branyan Decarlo Garcia, FNP

• Surgery Physician in Mountain Home AFB, ID
• Providers in Mountain Home AFB, ID by specialty
• Surgery Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.