MEDICARE: DR. RONALD R FLORES MD

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
1	207Q00000X	Family Medicine Physician	G067630	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CAQH11545227	OTHER	CA	CAQH

General Provider Information

NPI Number	:	1386610665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD R FLORES MD

Provider Business Mailing Address
First Line	:	2162 OUTRIGGER DR
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-3735
Country	:	US
Telephone Number	:	916-933-5372
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 CREEKSIDE DR
Second Line	:	SUITE 1400
City	:	FOLSOM
State	:	CA
Zip	:	95630-3444
Country	:	US
Telephone Number	:	916-984-8244
Fax Number	:	916-984-8388

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	07/08/2007

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