MEDICARE: MARIA E MORA MD PA

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	363A00000X	Physician Assistant	PA9104224	FL
2	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184657306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIA E MORA MD PA

Provider Business Mailing Address
First Line	:	91 BRANSCOMB RD STE 3
Second Line	:
City	:	GREEN COVE SPRINGS
State	:	FL
Zip	:	32043-7222
Country	:	US
Telephone Number	:	904-861-1034
Fax Number	:	904-861-1037

Provider Business Practice Location Address
First Line	:	91 BRANSCOMB RD STE 3
Second Line	:
City	:	GREEN COVE SPRINGS
State	:	FL
Zip	:	32043-7222
Country	:	US
Telephone Number	:	904-861-1034
Fax Number	:	904-861-1037

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARIA ELENA MORA
Credential	:	M.D.
Telephone Number	:	904-861-1034

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	01/06/2024

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Practice Location Address:

91 BRANSCOMB RD STE 3
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1508153651 — CARI DAHLMAN ARNP
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Practice Fax:

1871993287 — CASSANDRA ANDREWS
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1912462466 — APRIL LAWSON ARNP
Practice Location Address:

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Directions to “MARIA E MORA MD PA ” Practice Location

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