MEDICARE: NOEL MORA, MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332900000X	Non-Pharmacy Dispensing Site	ME71747	FL

General Provider Information

NPI Number	:	1083955991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOEL MORA, MD

Provider Business Mailing Address
First Line	:	7200 CORPORATE CENTER DR
Second Line	:	600
City	:	MIAMI
State	:	FL
Zip	:	33126-1200
Country	:	US
Telephone Number	:	305-500-2000
Fax Number	:	305-500-2080

Provider Business Practice Location Address
First Line	:	5201 HOLLYWOOD BLVD
Second Line	:	2 FLOOR
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6422
Country	:	US
Telephone Number	:	954-981-5200
Fax Number	:	954-981-1614

Authorized Official
Title or Position	:	VP SUPPORT SERVICES
Name	:	HOLLY LOPEZ
Credential	:
Telephone Number	:	305-500-2108

Provider Enumeration Date	:	03/04/2013
Last Update Date	:	03/04/2013

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