Provider Demographics
NPI:1699782185
Name:FLORES, EMILIO G JR (MD)
Entity type:Individual
Prefix:DR
First Name:EMILIO
Middle Name:G
Last Name:FLORES
Suffix:JR
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 1:120 THUNDER ROAD
Mailing Address - Street 2:P. O. BOX 309
Mailing Address - City:ST. MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857
Mailing Address - Country:US
Mailing Address - Phone:814-834-1920
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL AVE.
Practice Address - Street 2:
Practice Address - City:DUBOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-0447
Practice Address - Country:US
Practice Address - Phone:814-375-3261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-026296-E207U00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009619270007Medicaid
PA0961927Medicare ID - Type Unspecified
PA0009619270007Medicaid
PAC31682Medicare UPIN