Provider Demographics
NPI:1659686996
Name:WILLIAM C FLORES MDPA
Entity Type:Organization
Organization Name:WILLIAM C FLORES MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-853-3995
Mailing Address - Street 1:2634 GOLLIHAR RD
Mailing Address - Street 2:STE C
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-5200
Mailing Address - Country:US
Mailing Address - Phone:361-853-3995
Mailing Address - Fax:361-853-9702
Practice Address - Street 1:2634 GOLLIHAR RD
Practice Address - Street 2:STE C
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-5200
Practice Address - Country:US
Practice Address - Phone:361-853-3995
Practice Address - Fax:361-853-9702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB22733Medicare UPIN