Provider Demographics
NPI:1285993089
Name:FLORES, ROEL O JR (DO)
Entity type:Individual
Prefix:
First Name:ROEL
Middle Name:O
Last Name:FLORES
Suffix:JR
Gender:M
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 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6400
Mailing Address - Fax:
Practice Address - Street 1:1302 N PACIFIC ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:TX
Practice Address - Zip Code:75773-1022
Practice Address - Country:US
Practice Address - Phone:903-569-5383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ4102207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2616977-001OtherTRICARE
TX75-2616977-066OtherTRICARE
TX349498101Medicaid
TX75-261977-043OtherTRICARE
TX75-2616977-002OtherTRICARE
TX75-0818167-022OtherTRICARE
TX349498102Medicaid
TX75-2616977-028OtherTRICARE
TX8FF322OtherBCBS
TXP01570027OtherRAIL ROAD MEDICARE
TX433050YNSXMedicare Oscar/Certification
TX349498102Medicaid