Provider Demographics
NPI:1376548297
Name:FLORA, CONSTANTE J (MD)
Entity Type:Individual
Prefix:
First Name:CONSTANTE
Middle Name:J
Last Name:FLORA
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 1:4484 PAHEE ST
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-2031
Mailing Address - Country:US
Mailing Address - Phone:808-246-3800
Mailing Address - Fax:808-246-3801
Practice Address - Street 1:4484 PAHEE ST
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-2031
Practice Address - Country:US
Practice Address - Phone:808-246-3800
Practice Address - Fax:808-246-3801
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-9150207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07772504Medicaid
HI101621Medicare ID - Type UnspecifiedPAR EFFECTIVE 010107
HIF97706Medicare UPIN
HI56054Medicare ID - Type Unspecified