Provider Demographics
NPI:1679784631
Name:FLORES, AGUSTIN GILBERT R (MD)
Entity Type:Individual
Prefix:
First Name:AGUSTIN GILBERT
Middle Name:R
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 97
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35902-0097
Mailing Address - Country:US
Mailing Address - Phone:256-492-0131
Mailing Address - Fax:
Practice Address - Street 1:1989 SARDIS DR
Practice Address - Street 2:
Practice Address - City:SARDIS CITY
Practice Address - State:AL
Practice Address - Zip Code:35956-2344
Practice Address - Country:US
Practice Address - Phone:256-593-2371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL2750R207Q00000X
AL29739207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL113366Medicaid
AL113404Medicaid
AL113313Medicaid
AL113420Medicaid
AL113313Medicaid