Basic Information
Provider Information | |||||||||
NPI: | 1811947765 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | GERARD Q FLORES MD PLLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | NEPHROLOGY ASSOCIATES | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2000 HARTMAN RD STE 1 | ||||||||
Address2: |   | ||||||||
City: | FORT PIERCE | ||||||||
State: | FL | ||||||||
PostalCode: | 349474412 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7724651170 | ||||||||
FaxNumber: | 7724651171 | ||||||||
Practice Location | |||||||||
Address1: | 2000 HARTMAN RD STE 2 | ||||||||
Address2: |   | ||||||||
City: | FORT PIERCE | ||||||||
State: | FL | ||||||||
PostalCode: | 349474412 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7724651170 | ||||||||
FaxNumber: | 7724651171 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/11/2006 | ||||||||
LastUpdateDate: | 10/01/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | FLORES | ||||||||
AuthorizedOfficialFirstName: | GERARD | ||||||||
AuthorizedOfficialMiddleName: | Q | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 7724651170 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | M.D. | ||||||||
NPICertificationDate: | 10/01/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
ID | Type | State | Issuer | Description | AF1972086 | 01 | FL | DEA | OTHER |