=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538891601
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEAN CHRISTIAN DANIEL LAMOTHE FLORES MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2022
-----------------------------------------------------
Last Update Date | 09/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 365 MONTAUK AVE
-----------------------------------------------------
City | NEW LONDON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06320-4769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-442-0711
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1643 NW 136TH AVE H-100 (MSC11605-0002)
-----------------------------------------------------
City | SUNRISE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-377-2939
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 80487
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------