Provider Demographics
NPI:1821309675
Name:LARA, ELIAS FLORES JR (DO)
Entity Type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:FLORES
Last Name:LARA
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7696
Mailing Address - Country:US
Mailing Address - Phone:817-473-6063
Mailing Address - Fax:
Practice Address - Street 1:151 WALTON WAY STE 107
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-8010
Practice Address - Country:US
Practice Address - Phone:469-672-2100
Practice Address - Fax:469-672-2101
Is Sole Proprietor?:No
Enumeration Date:2010-06-27
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3814207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1H3426OtherMEDICARE
TX355643304Medicaid