MEDICARE: DR. ANTONIO MORA 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	ME0056780	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891729919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTONIO MORA M.D.

Provider Business Mailing Address
First Line	:	1435 W 49TH PL
Second Line	:	SUITE 305
City	:	HIALEAH
State	:	FL
Zip	:	33012-3197
Country	:	US
Telephone Number	:	305-557-3600
Fax Number	:	305-558-8555

Provider Business Practice Location Address
First Line	:	1435 W 49TH PL
Second Line	:	SUITE 305
City	:	HIALEAH
State	:	FL
Zip	:	33012-3197
Country	:	US
Telephone Number	:	305-557-3600
Fax Number	:	305-558-8555

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	04/13/2010

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Directions to “ DR. ANTONIO MORA M.D.” Practice Location

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