Provider Demographics
NPI:1467432021
Name:FLOR, JOHN MICHAEL
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:FLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 E MAIN ST
Mailing Address - Street 2:PO BOX 3037
Mailing Address - City:BLOOMING PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55917-3037
Mailing Address - Country:US
Mailing Address - Phone:507-583-2141
Mailing Address - Fax:507-583-7574
Practice Address - Street 1:405 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BLOOMING PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55917-3037
Practice Address - Country:US
Practice Address - Phone:507-583-2141
Practice Address - Fax:507-583-7574
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN82021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN812950OtherTRI-CARE
MN6B972ROOtherBLUE CROSS BLUE SHIELD OF