Provider Demographics
NPI:1295754166
Name:FLORES, WILLIAM DOMINGO (PA-C)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:DOMINGO
Last Name:FLORES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 SAINT CLAIR AVE NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-2004
Mailing Address - Country:US
Mailing Address - Phone:216-535-9100
Mailing Address - Fax:216-298-5015
Practice Address - Street 1:1530 SAINT CLAIR AVE NE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-2004
Practice Address - Country:US
Practice Address - Phone:216-535-9100
Practice Address - Fax:216-298-5015
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101746363AM0700X
OH50.007917RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291168000Medicaid
OH0007792Medicaid
FLE70987Medicare ID - Type Unspecified