MEDICARE: MR. RICHARD A FLORES CNIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZE0600X	Electroneurodiagnostic Specialist/Technologist	470	CO

General Provider Information

NPI Number	:	1003034679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD A FLORES CNIM

Provider Business Mailing Address
First Line	:	21933 E RIDGE TRAIL CIR
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80016-2665
Country	:	US
Telephone Number	:	303-426-3927
Fax Number	:	720-876-1315

Provider Business Practice Location Address
First Line	:	10940 S PARKER RD
Second Line	:	#130
City	:	PARKER
State	:	CO
Zip	:	80134-7440
Country	:	US
Telephone Number	:	303-426-3927
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2007
Last Update Date	:	07/08/2007

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