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General NPI Number Information
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NPI Number | 1205867595
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Entity Type | Individual
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Provider Name | ILDEFONZO FLORES M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1520 E SAN PEDRO DR SUITE 101
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City | LAREDO
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State | TX
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Zip | 78041
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Country | US
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Telephone | 956-724-1698
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 440843
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City | LAREDO
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State | TX
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Zip | 78044-0843
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Country | US
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Telephone | 956-724-1698
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Fax | 972-772-8099
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G8837
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License Number State | TX
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