Provider Demographics
NPI:1669960365
Name:WALLENTIN-FLORES, JOSHUA MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:MICHAEL
Last Name:WALLENTIN-FLORES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSHUA
Other - Middle Name:MICHAEL
Other - Last Name:WALLENTIN-FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:504 W FIR AVE
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1309
Mailing Address - Country:US
Mailing Address - Phone:928-853-9293
Mailing Address - Fax:
Practice Address - Street 1:107 E OAK AVE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1818
Practice Address - Country:US
Practice Address - Phone:928-779-7880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS31485207XX0801X
TN68056207XX0801X
AZ73668207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma