Provider Demographics
NPI:1578571725
Name:FLORES, ERNEST (MD)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:
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 1:119 MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-4111
Mailing Address - Country:US
Mailing Address - Phone:304-635-0110
Mailing Address - Fax:304-635-0104
Practice Address - Street 1:119 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-4111
Practice Address - Country:US
Practice Address - Phone:304-635-0110
Practice Address - Fax:304-635-0104
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV15939207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0091674-000Medicaid
WVE23736Medicare UPIN
WV0091674-000Medicaid