Provider Demographics
NPI:1740481266
Name:FLORES, STEPHEN R (IDC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:FLORES
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-1301
Mailing Address - Country:US
Mailing Address - Phone:757-966-2417
Mailing Address - Fax:
Practice Address - Street 1:USS HAWES
Practice Address - Street 2:MEDICAL DEPT
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09573 1507
Practice Address - Country:US
Practice Address - Phone:757-444-2507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman