Provider Demographics
NPI:1184933996
Name:ORTIZ FLORES, EDGARDO RAFAEL (MD)
Entity type:Individual
Prefix:
First Name:EDGARDO
Middle Name:RAFAEL
Last Name:ORTIZ FLORES
Suffix:
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 1:329 MAINE ST # E101
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3310
Mailing Address - Country:US
Mailing Address - Phone:207-373-2266
Mailing Address - Fax:
Practice Address - Street 1:329 MAINE ST # E101
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3310
Practice Address - Country:US
Practice Address - Phone:207-373-2266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22956207RH0003X
HIMD-24293207RH0003X
CAA144166207RH0003X
ME28108207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR12779-IOtherSTATE MEDICAL LICENSE
PR4554906OtherSTATE DRIVER'S LICENSE
CB260663Medicare UPIN