Provider Demographics
NPI:1760454565
Name:FLORES, VICTOR H (MD)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:H
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 678293
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8293
Mailing Address - Country:US
Mailing Address - Phone:817-336-7422
Mailing Address - Fax:817-338-0919
Practice Address - Street 1:901 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3010
Practice Address - Country:US
Practice Address - Phone:817-336-7422
Practice Address - Fax:817-338-0919
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4005208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX848658OtherBCBS
TX129743405Medicaid
TX848658Medicare PIN
TX848658OtherBCBS
TX129743405Medicaid