Individual provider Active NPI

Jesus Salvador Flores Banda, MD

  • Student in an Organized Health Care Education/Training Program
  • Tyler, TX
National Provider Identifier
1801534458
Registry record updated May 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
BP10080643 Issued in TX
Practice address
11937 US Highway 271
Tyler, TX 75708-3154
Phone
(903) 877-7777
NPI assigned
May 24, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X BP10080643 TX Primary

Addresses

Primary practice location

11937 US Highway 271
Tyler, TX 75708-3154

Mailing address

11937 US Highway 271
Tyler, TX 75708-3154
Phone (903) 877-7777

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220607003235 TX Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 6901284710

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
BP10080643TXMDStudent in an Organized Health Care Education/Training Program

Interoperability endpoints

  • Direct secure messaging: jfloresbanda703287@ahs.direct-ci.com

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1653350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653350400000",
    "number": "1801534458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11937 US HIGHWAY 271",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757083154",
            "telephone_number": "903-877-7777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11937 US HIGHWAY 271",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757083154",
            "telephone_number": "903-877-7777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLORES BANDA",
        "first_name": "JESUS",
        "middle_name": "SALVADOR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-05-24",
        "last_updated": "2022-05-24",
        "certification_date": "2022-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": "BP10080643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.