Provider Demographics
NPI:1912922386
Name:FLORES, EDWARD M (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:M
Last Name:FLORES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 COMMERCIAL CIR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2204
Mailing Address - Country:US
Mailing Address - Phone:936-756-2488
Mailing Address - Fax:936-756-3686
Practice Address - Street 1:110 COMMERCIAL CIR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2204
Practice Address - Country:US
Practice Address - Phone:936-756-2488
Practice Address - Fax:936-756-3686
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA89017207RP1001X
TXG5049207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122451103Medicaid
TX83J836Medicare PIN
TX122451103Medicaid