Healthcare Provider Details

I. General information

NPI: 1720127566
Provider Name (Legal Business Name): MARISA C FLORES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISA C FLORES KATHARD M.D.

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 S WILLIAMSON AVE
ELON NC
27244-9280
US

IV. Provider business mailing address

908 S WILLIAMSON AVE
ELON NC
27244-9280
US

V. Phone/Fax

Practice location:
  • Phone: 336-538-2416
  • Fax: 336-538-2395
Mailing address:
  • Phone: 336-538-2416
  • Fax: 336-538-2395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2004-0012
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2010-01589
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: