Healthcare Provider Details

I. General information

NPI: 1598749145
Provider Name (Legal Business Name): JOSE M FLORES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 COLONIAL DR STE 405
MARGATE FL
33063-5682
US

IV. Provider business mailing address

5800 COLONIAL DR STE 405
MARGATE FL
33063-5682
US

V. Phone/Fax

Practice location:
  • Phone: 954-969-0074
  • Fax: 954-969-0590
Mailing address:
  • Phone: 954-969-0074
  • Fax: 954-969-0590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number58134
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: