Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | MD-026296-E | PA |
NPI | 1699782185 |
---|---|
Provider Name | Dr. Emilio G Flores JR. |
First Address | St. Marys, PA 15857 |
Second Address | Dubois, PA 15801-0447 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0009619270007 | (05) | PA |
C31682 | (02) | PA |