MEDICARE: DR. RANDOLFO MORALES SCHMIDT 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	207R00000X	Internal Medicine Physician	9218	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	69621	OTHER	PR	BLUE CROSS
2	29218	OTHER	PR	CIGNA

General Provider Information

NPI Number	:	1639221187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDOLFO MORALES SCHMIDT MD

Provider Business Mailing Address
First Line	:	BOX 4185
Second Line	:	BAYAMON GARDEN STATION
City	:	BAYAMON
State	:	PR
Zip	:	00958
Country	:	US
Telephone Number	:	787-786-7014
Fax Number	:	787-740-0422

Provider Business Practice Location Address
First Line	:	30TH STREET AL17
Second Line	:	SANTA JUANITA
City	:	BAYAMON
State	:	PR
Zip	:	00956
Country	:	US
Telephone Number	:	787-786-7014
Fax Number	:	787-740-0422

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	04/26/2026

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