Basic Information
| Provider Information | |||||||||
| NPI: | 1285993089 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLORES | ||||||||
| FirstName: | ROEL | ||||||||
| MiddleName: | O | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 846098 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752846098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9033246400 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1302 N PACIFIC ST | ||||||||
| Address2: | |||||||||
| City: | MINEOLA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757731022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035695383 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2012 | ||||||||
| LastUpdateDate: | 02/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Q4102 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 75-2616977-001 | 01 | TX | TRICARE | OTHER | 75-2616977-066 | 01 | TX | TRICARE | OTHER | 349498101 | 05 | TX | MEDICAID | 75-261977-043 | 01 | TX | TRICARE | OTHER | 75-2616977-002 | 01 | TX | TRICARE | OTHER | 75-0818167-022 | 01 | TX | TRICARE | OTHER | 349498102 | 05 | TX | MEDICAID | 75-2616977-028 | 01 | TX | TRICARE | OTHER | 8FF322 | 01 | TX | BCBS | OTHER | P01570027 | 01 | TX | RAIL ROAD MEDICARE | OTHER |