Provider Demographics
NPI:1417238726
Name:FLORES, LILLIAM M (MD)
Entity Type:Individual
Prefix:
First Name:LILLIAM
Middle Name:M
Last Name:FLORES
Suffix:
Gender:F
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:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:AGUAS BUENAS
Mailing Address - State:PR
Mailing Address - Zip Code:00703
Mailing Address - Country:US
Mailing Address - Phone:787-438-4482
Mailing Address - Fax:
Practice Address - Street 1:APT.279
Practice Address - Street 2:
Practice Address - City:AGUAS BUENAS
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00703
Practice Address - Country:UM
Practice Address - Phone:787-438-4482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18188208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice