Provider Demographics
NPI:1164604930
Name:FLOWERS PEDIATRAIC CLINIC
Entity Type:Organization
Organization Name:FLOWERS PEDIATRAIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALONZO
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:870-534-1103
Mailing Address - Street 1:316 W 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71601-4214
Mailing Address - Country:US
Mailing Address - Phone:870-534-1103
Mailing Address - Fax:870-534-1819
Practice Address - Street 1:316 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-4214
Practice Address - Country:US
Practice Address - Phone:870-534-1103
Practice Address - Fax:870-534-1819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-24622080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA36510Medicare UPIN