Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | ME0072441 | FL |
NPI | 1013910249 |
---|---|
Provider Name | Dr. Antonio J Flores |
First Address | Ft Myers, FL 33901-4900 |
Second Address | Ft Myers, FL 33901-4900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 20/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01102 | BCBS (01) | FL |
200041646 | RR MEDICARE (01) | |
261367100 | (05) | FL |
H39801 | (02) |