MEDICARE: GARY E MORALES GERALDINO M. D.

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	208D00000X	General Practice Physician	28653-R	PR
2	208D00000X	General Practice Physician	ME122090	FL

General Provider Information

NPI Number	:	1083998090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY E MORALES GERALDINO M. D.

Provider Business Mailing Address
First Line	:	2460 OLD MOULTRIE RD STE 1
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32086-4198
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 PLANTATION ISLAND DR S STE 9
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32080-3106
Country	:	US
Telephone Number	:	904-460-9191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2011
Last Update Date	:	02/25/2026

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