Provider Demographics
NPI:1104087287
Name:FLORES, PATRICK HENRY (DO)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:HENRY
Last Name:FLORES
Suffix:
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 1:3100 N TENAYA WAY
Mailing Address - Street 2:POB 1569
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0436
Mailing Address - Country:US
Mailing Address - Phone:702-255-5025
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:3100 N TENAYA WAY
Practice Address - Street 2:POB 1569
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0436
Practice Address - Country:US
Practice Address - Phone:702-255-5025
Practice Address - Fax:702-671-6883
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO1486207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDO1486OtherNV MEDICAL LICENSE
IL036-119512OtherLICENSE
NVCS18031OtherNV PHARMACY CERTIFICATE
NVCS18031OtherNV PHARMACY CERTIFICATE
ILFF0574384OtherDEA