Provider Demographics
NPI:1508853938
Name:FLORES, ANTONIO A (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:A
Last Name:FLORES
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:PO BOX 414
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78156-0414
Mailing Address - Country:US
Mailing Address - Phone:830-379-8811
Mailing Address - Fax:830-379-4114
Practice Address - Street 1:214 NORTH CAMP ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5631
Practice Address - Country:US
Practice Address - Phone:830-379-8811
Practice Address - Fax:830-379-4114
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4374207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171796902Medicaid
TX171796902Medicaid
TXH83854Medicare UPIN