Basic Information
| Provider Information | |||||||||
| NPI: | 1922217918 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLORES | ||||||||
| FirstName: | ROBERTO | ||||||||
| MiddleName: | CHAVEZ | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4901 GRANDE DR | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325045935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504777042 | ||||||||
| FaxNumber: | 8504749060 | ||||||||
| Practice Location | |||||||||
| Address1: | 4901 GRANDE DR | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325045935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504777042 | ||||||||
| FaxNumber: | 8504749060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 03/06/2012 | ||||||||
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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 | 207L00000X | ME106751 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | A107447 | CA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | MD431389 | PA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | D0068238 | MD | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 0101244495 | VA | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 592-11592 | 01 | AL | BLUE CROSS BLUE SHIELD OF ALABAMA | OTHER | 002232400 | 05 | FL | MEDICAID | 148HF | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 119128 | 05 | AL | MEDICAID |