MEDICARE: AGUSTIN GILBERT R FLORES MD

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	L2750R	AL
2	207Q00000X	Family Medicine Physician	29739	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679784631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AGUSTIN GILBERT R FLORES MD

Provider Business Mailing Address
First Line	:	PO BOX 97
Second Line	:
City	:	GADSDEN
State	:	AL
Zip	:	35902-0097
Country	:	US
Telephone Number	:	256-492-0131
Fax Number	:

Provider Business Practice Location Address
First Line	:	1989 SARDIS DR
Second Line	:
City	:	SARDIS CITY
State	:	AL
Zip	:	35956-2344
Country	:	US
Telephone Number	:	256-593-2371
Fax Number	:

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	04/14/2011

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