Provider Demographics
NPI:1134185952
Name:FLORES, TESSA F (MD)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:F
Last Name:FLORES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-1637
Mailing Address - Country:US
Mailing Address - Phone:716-652-8606
Mailing Address - Fax:716-652-4448
Practice Address - Street 1:268 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-1637
Practice Address - Country:US
Practice Address - Phone:716-652-8606
Practice Address - Fax:716-652-4448
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229463207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA9713Medicare ID - Type Unspecified
NYI49990Medicare UPIN