Healthcare Provider Details

I. General information

NPI: 1043273519
Provider Name (Legal Business Name): JAIME JORGE FLORES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 N 6TH ST
HAINES CITY FL
33844-4207
US

IV. Provider business mailing address

141 N 6TH ST
HAINES CITY FL
33844-4207
US

V. Phone/Fax

Practice location:
  • Phone: 407-201-7918
  • Fax: 863-438-6624
Mailing address:
  • Phone: 863-353-1538
  • Fax: 863-438-6624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN292
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberACN292
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN 292
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number13735
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: