Healthcare Provider Details

I. General information

NPI: 1508924002
Provider Name (Legal Business Name): MIGUEL JOSE MORALES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 05/28/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 MDG OPC 80 BOX 5217
APO AP
96368-5217
US

IV. Provider business mailing address

18 MDG OPC 80 BOX 5217
APO AP
96368
US

V. Phone/Fax

Practice location:
  • Phone: 315-630-4780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME97002
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME97002
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: