Provider Demographics
NPI:1043234248
Name:FLORES, ROLAND (PA)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:
Last Name:FLORES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-3117
Mailing Address - Country:US
Mailing Address - Phone:210-922-7000
Mailing Address - Fax:210-928-4999
Practice Address - Street 1:3127 SE MILITARY DR STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-3990
Practice Address - Country:US
Practice Address - Phone:210-922-7000
Practice Address - Fax:210-928-4999
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00861363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX92020OtherCARELINK
TX8Y1203OtherBCBS
TX218520901Medicaid
TX8Y1203OtherBCBS
TXTXB112651Medicare PIN