Healthcare Provider Details

I. General information

NPI: 1023202306
Provider Name (Legal Business Name): GUSTAVO XAVIER MORALES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 08/10/2025
Certification Date: 08/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 GRANDVIEW PKWY STE 200
BIRMINGHAM AL
35243-3411
US

IV. Provider business mailing address

3680 GRANDVIEW PKWY STE 200
BIRMINGHAM AL
35243-3411
US

V. Phone/Fax

Practice location:
  • Phone: 205-971-7500
  • Fax: 205-971-7571
Mailing address:
  • Phone: 205-971-7500
  • Fax: 205-971-7571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number42631
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number42631
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMD36086
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number42631
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: