MEDICARE: DR. GLYCED FLORES-DEJESUS M.D.

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	207Q00000X	Family Medicine Physician	9179	PR

General Provider Information

NPI Number	:	1215930706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLYCED FLORES-DEJESUS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 9369
Second Line	:
City	:	CAROLINA
State	:	PR
Zip	:	00988-9369
Country	:	US
Telephone Number	:	787-755-8597
Fax Number	:	787-755-8597

Provider Business Practice Location Address
First Line	:	DOCTORS MEDICAL PAVILLION SUITE 20
Second Line	:	1394 CALLE SAN RAFAEL
City	:	SAN JUAN
State	:	PR
Zip	:	00907
Country	:	US
Telephone Number	:	787-755-8597
Fax Number	:	787-755-8597

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/31/2007

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Directions to “ DR. GLYCED FLORES-DEJESUS M.D.” Practice Location

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