Healthcare Provider Details

I. General information

NPI: 1356423263
Provider Name (Legal Business Name): MR. KENNETH M FLORES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E EXPRESSWAY 83 STE L-2
PHARR TX
78577-6506
US

IV. Provider business mailing address

200 E EXPRESSWAY 83 STE L-2
PHARR TX
78577-6506
US

V. Phone/Fax

Practice location:
  • Phone: 956-781-5800
  • Fax: 956-781-5873
Mailing address:
  • Phone: 956-781-5800
  • Fax: 956-781-5873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0079939
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: