Provider Demographics
NPI:1306032313
Name:MENJIVAR FLORES, EDUARDO JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:JOSE
Last Name:MENJIVAR FLORES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-316-5800
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:500 J CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1929
Practice Address - Country:US
Practice Address - Phone:757-594-2083
Practice Address - Fax:757-594-2196
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2017-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101246610207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV1043C - C03895Medicare PIN