Provider Demographics
NPI:1508196395
Name:FLORES, ELEAZAR (LSA)
Entity Type:Individual
Prefix:
First Name:ELEAZAR
Middle Name:
Last Name:FLORES
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:ELI
Other - Middle Name:
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:30715 GINGER TRACE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-4021
Mailing Address - Country:US
Mailing Address - Phone:281-210-9934
Mailing Address - Fax:
Practice Address - Street 1:30715 GINGER TRACE DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386
Practice Address - Country:US
Practice Address - Phone:281-210-9934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
TX88303246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSA00652OtherTEXAS MEDICAL BOARD