MEDICARE: DR. PATRICIA M MORALES 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	207Q00000X	Family Medicine Physician	C55742	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00284878	OTHER	FL	MEDICARE RR

General Provider Information

NPI Number	:	1649264540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA M MORALES M.D.

Provider Business Mailing Address
First Line	:	2710 REW CIR
Second Line	:	SUITE 200
City	:	OCOEE
State	:	FL
Zip	:	34761-2967
Country	:	US
Telephone Number	:	321-221-0665
Fax Number	:	407-654-9614

Provider Business Practice Location Address
First Line	:	2710 REW CIR
Second Line	:	SUITE 200
City	:	OCOEE
State	:	FL
Zip	:	34761-2967
Country	:	US
Telephone Number	:	321-221-0665
Fax Number	:	407-654-9614

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	04/15/2015

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