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NPI Code Detail

MEDICARE: JONATHAN FLORES PA

MEDICARE: JONATHAN FLORES PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA07374TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134417298
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN FLORES PA
Provider Business Mailing Address
First Line : 5015 FORT AVE
Second Line :
City : WACO
State : TX
Zip : 76710-5828
Country : US
Telephone Number : 817-431-0606
Fax Number :
Provider Business Practice Location Address
First Line : 7630 N BEACH ST STE 140
Second Line :
City : FORT WORTH
State : TX
Zip : 76137-3016
Country : US
Telephone Number : 817-281-2977
Fax Number : 817-788-2530
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2011
Last Update Date : 10/02/2019

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Directions to “ JONATHAN FLORES PA” Practice Location

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