MEDICARE: DR. LISA FLORES M.D.

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	25MA09407600	NJ

General Provider Information

NPI Number	:	1720496755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA FLORES M.D.

Provider Business Mailing Address
First Line	:	1230 WHITEHORSE MERCERVILLE RD
Second Line	:
City	:	HAMILTON
State	:	NJ
Zip	:	08619-3838
Country	:	US
Telephone Number	:	609-581-1700
Fax Number	:	609-581-9957

Provider Business Practice Location Address
First Line	:	1230 WHITEHORSE MERCERVILLE RD
Second Line	:
City	:	HAMILTON
State	:	NJ
Zip	:	08619-3838
Country	:	US
Telephone Number	:	609-581-1700
Fax Number	:	609-581-9957

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

Provider Enumeration Date	:	07/22/2014
Last Update Date	:	07/22/2014

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