Healthcare Provider Details

I. General information

NPI: 1598939555
Provider Name (Legal Business Name): JOHN A FLORES MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2902 HILLRISE DR
LAS CRUCES NM
88011-4702
US

IV. Provider business mailing address

2902 HILLRISE DR
LAS CRUCES NM
88011-4702
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-5755
  • Fax: 575-521-9385
Mailing address:
  • Phone: 575-522-5755
  • Fax: 575-521-9385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2002-0142
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number2002-0142
License Number StateNM

VIII. Authorized Official

Name: DR. JOHN A FLORES
Title or Position: PRESIDENT
Credential: MD
Phone: 575-522-5755