Provider Demographics
NPI:1356446454
Name:FLOREZ, HENRY (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:FLOREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 S AVENUE B
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6903
Mailing Address - Country:US
Mailing Address - Phone:928-344-9166
Mailing Address - Fax:928-344-3476
Practice Address - Street 1:2680 S AVENUE B
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6903
Practice Address - Country:US
Practice Address - Phone:928-344-9166
Practice Address - Fax:928-344-3476
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22148207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ158239Medicaid
860970379OtherFED TAX ID NUMBER
AZZ111381Medicare PIN
AZZ22876Medicare PIN
AZF66581Medicare UPIN
AZ158239Medicaid