Provider Demographics
NPI:1851614010
Name:FLORES, CARLOS LEE (PA)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:LEE
Last Name:FLORES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 W 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1709
Mailing Address - Country:US
Mailing Address - Phone:806-350-2663
Mailing Address - Fax:806-350-2665
Practice Address - Street 1:7000 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1709
Practice Address - Country:US
Practice Address - Phone:806-350-2663
Practice Address - Fax:806-350-2665
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06545363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX818N86OtherBCBS
TN8L27067Medicare PIN