Provider Demographics
NPI:1891715157
Name:FLORES, MIGUEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:J
Last Name:FLORES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 W DALLAS
Mailing Address - Street 2:#4
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301
Mailing Address - Country:US
Mailing Address - Phone:936-760-2300
Mailing Address - Fax:936-756-7331
Practice Address - Street 1:804 W DALLAS
Practice Address - Street 2:UNIT #4
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301
Practice Address - Country:US
Practice Address - Phone:936-760-2300
Practice Address - Fax:936-756-7331
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7398207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096440503Medicaid
TX096440503Medicaid
TX8B2572Medicare PIN