Provider Demographics
NPI:1013913045
Name:FLOWERS, JEREMY RAY (NP)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:RAY
Last Name:FLOWERS
Suffix:
Gender:M
Credentials:NP
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 232410
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9000
Practice Address - Country:US
Practice Address - Phone:800-926-8273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15316363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0083811Medicaid
CAGR0083816Medicaid
CAGR0083817Medicaid
CAGR0083810Medicaid
CAGR0083814Medicaid
CAZZZ75341ZMedicaid
CAGR0083812Medicaid
CAGR0083813Medicaid
CAGR0083815Medicaid
CAW529AMedicare PIN
CATP110Medicare PIN
CAW529Medicare PIN
CAHW529AMedicare PIN
CAGR0083810Medicaid
CAGR0083817Medicaid
CAGR0083816Medicaid
CAZZZ75341ZMedicaid
CAGR0083813Medicaid