Provider Demographics
NPI:1912007485
Name:OLIVEIRA, LIDIA FLORES (DO)
Entity Type:Individual
Prefix:DR
First Name:LIDIA
Middle Name:FLORES
Last Name:OLIVEIRA
Suffix:
Gender:F
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:PO BOX 22795
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32830-2795
Mailing Address - Country:US
Mailing Address - Phone:407-248-9003
Mailing Address - Fax:407-248-0445
Practice Address - Street 1:917 RINEHART RD
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4802
Practice Address - Country:US
Practice Address - Phone:407-248-9003
Practice Address - Fax:407-248-0445
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6402207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371401201Medicaid
FLH05355Medicare UPIN
FL371401201Medicaid