Healthcare Provider Details

I. General information

NPI: 1043286586
Provider Name (Legal Business Name): JOSE LEOS FLORES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 ANTHONY DR
ANTHONY NM
88021
US

IV. Provider business mailing address

385 CALLE DE ALEGRA STE A
LAS CRUCES NM
88005-3423
US

V. Phone/Fax

Practice location:
  • Phone: 575-882-5706
  • Fax: 575-882-2909
Mailing address:
  • Phone: 575-526-1105
  • Fax: 575-524-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number91-47
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: